Rage and Entitlement in Borderline Personality Disorder

A site visitor who signed with the name “Jay” recently left an interesting comment to my earlier post on borderline personality disorder. As this bears on the issue of rage and the sense of entitlement, I’ll quote his remarks at length. He’s a young mental health professional, working at an in-patient facility:

“I have one BPD patient. Just one and the stress is starting to get to me. It is becoming a nightmare. She cuts, threatens suicide, hits her peers, urinates on the floor and yells at the top of her lungs when she does not get her way. She pulled the fire alarm during her tour of the building because she wanted to be let in the music room. That room was under construction. I explained to her why she could not go in there, her answer was “how do you know?” I pointed to the “under construction keep out” sign. She replied “well you still don’t know that.” She then proceeded to yell at me for not taking her side.

Another example, she ordered cereal for breakfast the night before. She woke up and asked for oatmeal and bananas. We did not have any oatmeal. We offered cereal and bananas. She flipped a few chairs, threw her tray at the kitchen staff, threatened to kill herself and burn the place down. That lasted 3 hours. There was no talking with her, no pacifying her. Finally she was placed in restraints and medicated. She sleeps 10 hours.

Empathy does not work, group therapy, one on one, drawing, meditating, bribery, nothing . Yes, I bribed her with snacks, tried a few reward systems. She’s in her early 20s, as I am. I can not reach that girl. She hates me one day and can not live without me the next. My colleagues are all sick of her. Being the youngest of the staff, she’s is mine until she leaves. I am seriously considering switching to hospice care. She has no boundaries and does not respect mine. For example, I stated that I am uncomfortable with kissing on the cheeks, hugging, holding hands and such. However I do shake hands. She will try to hug me every time I see her, or touch my clothes, hair, to touch my papers. I’d say “please don’t”, she’d say “but I want to see what it is” or “they are just papers”. Yes papers that are on my lap . That make my blood boil.”

In this comment, Jay dramatically illustrates the emotional challenge of working with someone who suffers from borderline personality disorder. His reactions are not unusual; I have felt very similar ways during sessions with my own clients. His account also reminds me of other such stories I’ve heard, about the way bpd patients affect their ward staff. They are highly provocative and evocative; they inspire feelings of hostility and resentment. They make you want to quit the profession.

In order to help someone like this young woman, you first have to get clear on the difference between empathy vs sympathy. Jay states that “empathy does not work,” but I doubt he or anyone else on the staff is truly empathizing with her … at least they’re not aware that they are. She fills them (via projection) with all her own unbearable emotions of rage and anger; the way she treats her caretakers evokes the same feelings within them that she is struggling with. Jay says her behaviors make his “blood boil” — that’s where the empathy comes in. The problem is that, for the most part, we mental health professionals believe it’s inappropriate to have such feelings, and when we’re forced to admit that we do have them, we want to blame the patient.

What I recommend instead is to use those feelings to connect with her. In my response to Jay, I suggested that he say something to his patient like this: “When you can’t force me do what you want, it makes you so furious you hate my fucking guts and want to kill me.” It’s clear from what Jay writes that she’s struggling with murderous rage and it’s important to name it for her, to articulate the emotions and impulses she’s feeling. It’s easy to assume that she knows what she’s feeling; the truth is, her mind is continually blown apart by the violence of her feelings; she doesn’t really know what they are in any way you or I would recognize. It’s the job of the therapist to help her bear with those feelings and learn to understand them — very difficult work.

This young woman also finds any kind of frustration unbearable; she’s goes into a rage whenever she feels it. In part, this reflects the sense of entitlement you so often find with borderlines; it also betrays the limits of her capacity to bear any kind of pain. She demands to be treated as if she were an infant, really — ministered to by a perfect mother who would tend to her every need and never let frustration become an issue. It would be important to address this with the patient: “I think you find any kind of frustration unbearably painful; when you feel it, you just want to kill somebody.” With my own clients, I’ve also said things like: “You expect me to understand and gratify your every need without you having to say a single word.”

Neither can she bear the experience of separateness; those boundary-crossing behaviors that understandably annoy Jay represent her attempt to take possession of him, to own him, and to deny the separation between them. When the experience of need, separateness and frustration is unbearable, fantasies of merger often come to the rescue. If she “owns” Jay by merging with him, then on some level, she believes she won’t have to feel frustration, or become enraged when he doesn’t instantly do what she wants him to do. When she feels “at one” with Jay, she “loves” him (it’s not really love, of course); when she experiences him as separate and frustrating, she wants to kill him. To me, these are familiar borderline dynamics.

I feel for Jay. His comment is overflowing with all the unbearable emotion she inspires in him. Using those feelings as a guide to the patient’s emotional experience (countertransference in the broad sense) is the only way to make the work bearable for the therapist, and the only way you can truly help someone this troubled. In my experience, it also helps you feel more compassionate toward their suffering. It is painful and often terrifying to feel murderous rage. If Jay, with his healthier mind and greater mental capacities, finds it so difficult, imagine how hard it must be for his patient to bear with her experience. By using your reactions as a guide to understanding your client (instead of feeling quietly guilty because you hate her), you’ll truly empathize with her experience, and probably feel a lot more sympathy as well.

Joe is the author and the owner of AfterPsychotherapy.com, one of the leading online mental health resources on the internet. Be sure to connect with him on Google+ and Linkedin.

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54 Responses to Rage and Entitlement in Borderline Personality Disorder

  1. Evan says:

    Blaming others is such an attractive option: “They make you want to quit the profession.”

    I do like the way you recommend staying connected while differentiating (my summary). I’m glad you don’t buy into (his) blaming the client too.

    • Joseph Burgo, Ph.D. says:

      Evan, I’m sure you’ve seen a lot of that blaming, too. It’s understandable — a way of putting distance between yourself and this overwhelming amount of pain — but it won’t help you or the client to cope with it.

    • Jay says:

      I have been cleaning urine and feces off her floors for over 2 weeks now. I have had my shirts ripped, my butt pinched, slipped and fell in her urine too many times to count. My other charges are neglected. She takes up all my time.

      She gives me heartburns. I have knots in my stomach when I walk in the door. I am anxious and cranky. I hear her in my sleep telling me she’s going to find me and kill my cat. Her rages are violent, so raw and ugly.

      Yes I signed up to work with difficult patients. However, I am also person with feelings and a clothing budget. Pretending that her behavior does not affect me would be a lie. I went home with a black eye Thursday night.

      “Blaming the client?” Me? Nah. Never. She can slap me , push me , pull my hair, spit on me , I am not going to blame her . I know she is sick. I am getting paid to help her but I am also being abused, and that freaking sucks. So yes, I think that I am allowed to be angry at her for not letting me do my best.

      My job suffers from her behavior. I can not work with my other charges because of her. She monopolizes my time. Out of 8 hours, she takes 7. My other darlings are left in the cold.

      For example, I was talking with a charge, she walked right in to the girl’s room and sat on her bed. I said “X, I am with Y right now, give me a minute and I’ll be out”. She replied ” nope, I’m gonna sit right here t’ill you’re done with that dumb b*tch.”

      Y got up and left, angry at me.

      Repeat that scenario n time per shift. If I dared to not run when she calls, I’ll be cleaning up feces or urine, or she might corner me and slap me around a bit.

      Later on Y was found in the shower, cutting. I could not even go to her because I was holding court at X’s.

      No I do not blame her but I am angry at her. I am angry because she won’t let me help her. She is not even trying me meet me 1/3 of the way. She wants my time but not for therapy, she wants to watch TV, paint her nails, chat and gossip. As soon as I say something about dealing with even a minor frustration, I am the bad guy.

      For example, after an episode we are supposed to debrief. She refuses. She acts like she did not do anything wrong. She just erases the bad behavior and expects everyone to do the same.

      She does not talk about what’s going on in her mind, she blocks all emotions that she finds unpleasant and if I dare push I get hit. There is no therapeutic report. It’s a hostage situation, I do what she wants or I pay.

      Thank you for your time and advice.
      Jay

      • Joseph Burgo, Ph.D. says:

        Honestly Jay, my heart goes out to you. ANYONE would find this patient a challenge. I don’t think I can say much that will make it any easier, but I’d point out to you that you’re expecting too much from her. “She refuses” to debrief. She won’t “let you” help her. It’s a case of can’t, not won’t. She IS engaged with you and is showing (not telling) you all about her difficulties. She feels unbearable rage and hatred when she doesn’t get her way, or when she feels jealousy of your contact with someone else; she expresses that rage by shitting and peeing all over the place, by physically assaulting you, making violent threats, etc. She CAN’T control herself. She doesn’t know how to bear her feelings, and in this way, she is like a small baby. Yes, you ARE the bad guy when she feels even a minor frustration. It’s the way babies experience frustration — as if it is a BAD thing caused by a BAD object (i.e., you). There’s so much that’s revealing in what you say about her, but I don’t know that you have the conditions to give her what she actually needs. What she needs is someone who can understand how painful and terrifying it feels to BE her, overwhelmed and overpowered by every emotion; unbearably small and needy, and no doubt self-hating at some deep level. All the emotional violence you experience takes a terrible toll on her, as well. Of course, it’s easy for me to sit here and write these words because I’m not the one she’s slapping, nor have I slipped in her pee. You have a monumental challenge on your hands, Jay.

      • Liv says:

        Jay, as a recovered borderline, you are harming this girl more than you are helping her. Give it up and refer her to someone who knows what they are doing. Borderlines are some of the most difficult people to treat, and it is disgusting that your place of employment gives borderline patients to the least experienced doctors. It is not fair to the patient who is suffering so deeply. She deserves a doctor who can help her. Please refer her to a true professional who can do DBT with her.

        • Joseph Burgo, Ph.D. says:

          I was reluctant to approve this comment but I thought you should have your say. On Jay’s behalf, I will point out that there are not enough seasoned therapists out there to see all the people who suffer from borderline issues. Further, because of their emotional difficulties, they often lead financially marginal lives and can’t afford to see anyone senior. I’d also add that, as with all “recovered” borderlines, you still have that ability to rage in hurtful ways. What you said to Jay was harsh and self-righteous.

          • Liv says:

            How was what I said self-righteous? Why are you sticking up for Jay who is obviously in over his head? You obviously have no idea what the pain of BPD is and are only seeing the situation from a “normal” person’s perspective.

            • Joseph Burgo, Ph.D. says:

              On the contrary, I’ve worked with and empathized with people who suffer from borderline issues for years.

              • Carter Michael Dohoney says:

                Late in the coming as this is, Doctor, I’d just like to express how well you handled Liv here. It’s rather marvelous how you called her to account without persecuting her, and your capacity to remain professional and calm is enviable.

                Feel free not to approve this comment. I don’t want to spark anything resembling an escalation even at this late date, but I did want to voice this sentiment, and comments are the most immediate venue.

                • Joseph Burgo says:

                  Sorry I took so long to approve your comment! The last couple of weeks have been intense, with the annual move cross-country back to North Carolina. I don’t think your words will escalate the conversation.

          • Jen says:

            Dr. Burgo, I think you may be mistaken in thinking that Jay is a therapist. From the things published here, it seems much more likely that he’s a tech or a nurse on an inpatient unit. A therapist probably wouldn’t be asked to clean up urine or feces, nor is he likely to be involved in breakfast orders. Also, referring to his “charges” and “little darlings” is unusual terminology for a professional therapist.

            Given that, I think Liv makes a point about asking that this patient be transfered to another staff member if one is available. Jay obviously has a tremendous amount of anger towards her (though I’m not saying that’s unjustified) and he seems to be overpersonalizing her illness. He’s angry not because she’d make most people angry, but “because she won’t let [him] help her”, but he can’t see that she will get well or not in her own time and that is not a reflection on HIM. A huge part of the recovery in BPD is learning that one is capable of controling one’s emotions and behaviors by ONESELF, not learning to lean on someone else for that control.

        • Dolma Beck says:

          What sort of facility allows physical violence
          Towards staff? Surely this must not
          Be tolerated ?

  2. Wendy McIntosh says:

    First I want to tell you thank you for your very heartwarming advice to “Jay”. It seems like those with BPD will never overcome the stigma of the disorder most mental health professionals love to hate! I have BPD. I can tell you that the patient Jay described is complete out of her skin with terror, rage, desperation, and loneliness. Her life is one terrifying moment after another. She can not see that every other human being is not feeling exactly what she is, and she can not understand why they are so much in control of the fear that consumes her. Just one time, one simple step of someone clearly naming out loud exactly as you described what she is feeling will be the first step to her self awareness and her journey of finding a way to live peacefully in the world! She may not react like it is a that ah ha moment, but believe me she will save that second when some one names the feeling, she will test it over and over. She’s been hurt in the past in so many ways to what appeared to be something to alleviate the pain, so she isn’t going to trust it right away. But she will. Working with someone with BPD can be pure hell, but it also can be the most significant work of one’s life, because when you are able to get past the barriers that have been erected to protect themselves you may find a truly rewarding experience of helping someone really heal. I consider my therapist to be a saint and a savior. She stuck with me, she kept me alive long enough to find the light of day and she has shared in the thrill of my finding joy in life again! Thank you so much for this post.
    Wendy

    • Joseph Burgo, Ph.D. says:

      Wendy, I have found that my work with clients like the one Jay described has been the most difficult AND the most rewarding work I’ve done. I suppose because my own therapist went to this place with me and helped me learn to bear such feelings, I have a lot of sympathy (and empathy) for borderlines. And it is incredibly moving to help them get to the point where they can bear their feelings and aren’t blown apart by them, to go to that place of pure terror and survive. I’m glad you found a therapist who is doing the same for you.

    • Tiffany says:

      I have bpd….I am 30yrs old and more scared now than ever before…I always pushed people away because I feared the pain they would cause me…The anxiety of it all was to much…I turned to drugs,drinking, and self hurt…I found love…Real love or so I think so…I am not sure what I think anymore…He tells me I am dillusional, that I make no sense…He even punished me and left without a trace locked his cell phone and said it was all to gain trust from me…He knows I fear being left…He knows I fear him coming to terms of things I have done and doing them back…I was so scared I felt like I was having a heartattack…He left twice to go one place and didn’t return until it suited him…I was a complete wreck after all that…Mentally I am in a nightmare I want to wake up from…I am a good mother, I do not hit my kids or talk in a way that hurts them…I never realized the reality of bpd till 10yrs ago almost in meeting my husband…He out of nowhere says he is done and I really just do not get it…This time I really did nothing…I tried to explain how it hurt me…He said see, listen to yourself…I need some time to myself and you are freaking out…We have a family together and I was just trying to say that him doing that left us wondering where he was, he wouldn’t say anything back and just bailed…He could have been in a ditch dead or jail I didn’t know…Yes cheating came to mind but even that seemed out of charcter for him…I was truely hurt by him…I admitt my wrongs and sometimes I feel like I am going to pop with stress because I try to control myself so much…I have came a long way in trying the self control thing…I make dinner, clean, I do everything possible and even try to have set days of family time and yet he still now tries to make me feel like I am wrong in how I am trying to get better…I am more scared than before…I feel because of how people have handled me and how I reacted in my past that I will be alone…I am suspose to be alone…Hell he even said, “I hope you die alone”…I admitt when something goes wrong it’s him I turn to as a source to relieve the stress….WRONG on my part but, do I deserve to feel my worst fears because he creates them for me? I think I rubbed off on him and he is now doing as I did and making it justified…I am in a bad dream…How do I let go when I know I am better under all this bad???

  3. It is very exhausting to keep our cool in the midst of emotional vampires (the chronically mentally ill) on a day to day basis. Running mile after mile on a daily basis before work saved my sanity during the 4 years I worked at a day treatment facility. Yes, saying and expressing out right to the patient how you feel about the interaction and relationship would relieve the internal battle and help things move along.

  4. sarah says:

    very helpful, i can relate to the feelings you speak of from the side of being the patient, you explain them very well for me, particularly the frustration intolerance, i may not have acted out in the way of that patient but i often find it very hard to hold myself back from extreme emotions and behaviour, a massive reaction to any pain or frustration , and i have hated and loathed myself for it yet feel very under the grip of it, and terrified of its strenght, like a monster inside, that im constantly trying to stop. it stops me from living any normal social life or working which is a constant sadness as i watch my life pass me by.

    there but for the grace of god have i not crossed the line where i need to be hospitalised like that girl and it must be horrible to deal with for the staff,

    but if the staff can deal with it like you say then they have the opportunity to be part of changing a life from one of constant pain and suffering to one of hope and light, and that is priceless.

    Im in therapy and my therapist says she understands its not personal and that if with challenging and in a trusted environment she can withstand the rage that comes out, we could do some good work together,

    i hope so, im terrified i will destroy my therapist cos thats how that part of me is, but i keep taking a chance and trying to push myself and to listen and start to bear the frustrations a little more each time.

    its so horrible to know that how you are has the effect on people that you speak of in your piece. that is crippling but the more i can face up to how part of me is, without so much crippling shame, but still love myself, that will be one of the keys needed tomoving forward i think,

    • Joseph Burgo, Ph.D. says:

      You’re very fortunate to have found a therapist who can bear with your hatred. In my experience, it’s the only way to help someone who struggles with these borderline issues.

      • Anonymous says:

        Except it is likely a matter of time until any therapist is pushed to their limit. It’s a job and at some point, enough is enough. Most therapists I’ve worked with have low thresholds and thin skin.

  5. Paisley says:

    Again, a valuable post. And the comments that result from others, also informative. Please keep it coming. Many of us are trying to move along in our own recovery by trying so hard to understand the dynamics of it all. This is one of those helpful pieces.

  6. A Reader says:

    Very interesting article. To me especially interesting about the patient who made Jay`s head “boil”.
    It goes both ways, even if no particular behaviour is acted out. About 35 yrs ago I was a patient in a psychiatric ward, and for some reason the whole me was in turmoil. I did not act out anything, however I hold it likely that I looked like bad weather coming. I went to the chief nurse and asked to be released from the hospital, and was told to go my room and she would send someone to speak to me. A night warden came and sat down, he looked very open and receiving , but said nothing. Nor did I. Five minutes might have passed, may be ten or even more. And suddenly it dawned on me what was taking place, and I said: “Thank you for the calm you are giving me.”

  7. Looveey says:

    Hello Joseph

    Thankyou for sharing both sides of the coin. It has helped me to understand how high emotion can effect the therapeutic relationship and it has allowed me to have compassion for both myself and the other person in a therapeutic relationship.

    I appreciate that this may be outside the scope of your current post but I will ask anyway and trust that you will let me know. My question is as a patient how to respond to this counter-transference of rage. Now I can see what is happening for him what would be a compassionate but limit setting response.

    If it is relevant I ask this in the context of being wrongly diagnosis with bpd only to have this replaced by an Axis 3 condition. My medical team have accepted this diagnosis and sought to have it corrected. In contrast the psychiatrist at the local hospital who made the diagnosis is in a constant state of rage towards me and keeps making bpd type accussations. I have been able to limit but not avoid his involvement for structural reasons.

    My question really relates to the other side of the coin of how to manage the counter-transference.

    • Joseph Burgo, Ph.D. says:

      It’s not your place to manage the counter-transference — it’s his. If your former psychiatrist is in “a constant state of rage towards” you, then he has a serious problem. He may have experienced the correction of his diagnosis as a kind of narcissistic injury; he may be feeling humiliated in front of his colleagues and is taking it out on you. But there is nothing you can do about it other than to limit your contact. If it goes on, you might want to consider a different setting.

  8. Gary says:

    This brings to mind a Grace Jones oldie called “The Hunter Gets Captured By The Game.” I think the environment of being hospitalized brings out a lot of the drama. Since it seems like the lowest possible place for an individual to wind up, I think many patientst “go for broke” with their behavior. If and when they get better, the behavior is forgotten. But testing those “in the profession” becomes a battle of rage and control. There is that sense, “Why am I here, and why do you go home at night? What makes you “sane” and me not?”

  9. Marie says:

    I would love to hear more about your work with BPD. My mother has bpd, and my childhood was hell. I’m in therapy to deal with those wounds, but also have the ongoing struggle of my adult relationship with my mom. I always took care of her when I was a kid, and now, I have firm boundaries. (And children of my own to care for and protect!) It’s so difficult to maintain the boundaries and even know what she is capable of doing herself. I am the only family member who has any contact with her at all. And even that little bit of contact wears me out.

    My heart goes out to people with bpd because it must be horrible. I wish my mother would stick with treatment. She’s been in and out of hospitals and therapy for fifteen years with no improvement at all. It breaks my heart to see her old, vulnerable, and truly alone.

    • Joseph Burgo, Ph.D. says:

      I intend to write more about this subject. It’s where the biggest part of my experience has been. I think I’m next going to write something about the role shames plays in bpd, about the transformation of rage into shame that happens in a good psychotherapy session.

  10. M. says:

    I think one thing I’d like to mention, (Haven’t read the whole article yet, will come back and finish later.) Is that the gentleman said “She has no boundaries.”

    Without the ability for her to have the power to set personal boundaries she may feel confused about what it is to respect others boundaries. She may also be cut off from herself and her senses and that makes it hard to communicate, understand and know others boundaries. She sounds like she is in a state of desperation, possibly fear.

    Let’s say a parent is domineering and doesn’t respect the child’s boundaries she wouldn’t have any self- worth or boundaries. It might help out for her to learn how to set personal boundaries, and also about respecting them… She didn’t learn either. Then by doing so she could begin to get in touch with herself and find out more what she wants so that she could give that to herself. Then she will set healthy boundaries, respect them, be more in touch with herself, and won’t be looking outside of herself to get what she wants. ;-)

    That would be important for her.

    • Jay says:

      Don’t I wish it could be that simple.
      This woman is either trying to convince me that we should get married/ date/ have sex or she is slapping me silly.

      For example 0730, wake up time. Break fast is ready. She is in bed. I knock, she wakes up. I either get ” Get the f*ck out, I’m f*cking tired of you waking me up every mother f*cking day” . I run. She is in a bad mood , pushing her will result in chaos.

      Or I hear “Hey baby, come give me a kiss.”

      By the way, she sleeps naked and insists on having the staff dress her in the morning.
      I can get her tray and have her eat in her room (angering other patients in the process, for we do not allow food in the rooms) or I can try to get some clothes on her. If I refuse to dress her, she’ll come out naked and oh she has.

      • Joseph Burgo, Ph.D. says:

        Jay, I didn’t mean to imply it was easy. The kind of interpretations I make have to be made over and over again, month after month; she’s not going to change just because you say it once. And I think I may have been a little cavalier in suggesting to you what I did. I think you’re in an impossible situation because you need her to behave in certain ways in order for the ward to function; you have to find ways to bring about compliance, which isn’t terribly compatible with the type of intervention I’m suggesting.

  11. Grace says:

    Just want to say that your statement “… it’s important to name it for her, to articulate the emotions and impulses she’s feeling. It’s easy to assume that she knows what she’s feeling; the truth is, …. It’s the job of the therapist to help her bear with those feelings and learn to understand them — very difficult work.” just about sums up my experience of one of the major gifts of therapy. In my experience, you don’t have to have any major mental “disorder” to benefit from such work. Naming & understanding feelings, wounds, defenses, … I didn’t know I had were priceless lessons I learned in therapy! I have tried to apply this with others I relate with, mainly my kids, and it has helped me tremendously in relating to them as well, and hopefully, becoming a better mother. I wish therapy was targeted to the general population, I believe so many people in the spectrum of “normal” functioning can truly enrich their lives and benefit from it. Why isn’t it mainstreamed???
    The other comment you made, “If Jay, with his healthier mind and greater mental capacities, finds it so difficult, imagine how hard it must be for his patient to bear with her experience.” is also so on point! Not to be self-righteous, but I use that reasoning so much with my kids, co-workers, other mom’s … Thanks again for your posts, my hats off to you for both posting and to all therapists, you do have a difficult work, but you make such a difference in people’s lives!

    • Joseph Burgo, Ph.D. says:

      I like your approach with your co-workers, etc. — it’s useful (but also difficult) to bear in mind that other people don’t have the same emotional capacities that you do. I think it’s natural for us to assume other people can do exactly what we do but simply won’t, or don’t care enough to make the effort. Some people are simply incapable of certain emotional tasks we take for granted.

  12. Mark says:

    Some neuropsychologists like Marion Solomon have come to believe that the roots of BPD lie in early childhood sexual abuse. And that talk therapy which fails to express dissociated body memories is only going to be modestly successful. I’d love to see a group of BPD patients treated through a program like Model Mugging (www.modelmugging.org) or The Possibility Project (http://the-possibility-project.org/) compared to a control group of conventionally treated BPD sufferers.
    My hypothesis would be that the neural integration in prefrontal areas of the brain that results from these programs would produce a measureable significant difference.

    • Joseph Burgo, Ph.D. says:

      I’ve seen far too many cases of bpd without any kind of childhood sexual abuse to subscribe to that theory. Also, I’m not sure what you mean by “conventionally treated BPD sufferers.” Is there a conventional treatment? In my experience, when I tell colleagues that I work with BPD, they want to start referring to me. As far as I can tell, nobody wants to work with these people. I guess you mean treated “by other traditional methods” — like CBT and DBT.

      • Mark says:

        It would be interesting to know what evidence you have that supports the “no sexual abuse” claim.
        (Things happen to children before memories are put into language). Just as it would similarly be interesting to investigate Marion Solomon’s claim that is often a root cause. Because of the complexity of the brain and the way it represses and distorts memories, I feel pretty comfortable asserting that something(s) happened that disorganized the BPD suffer’s capacity for operating in the world with a sense of compassion, safety and trust. In my limited experience, emotional episodes in such people often have the feel and flavor of a terrified infant or child. Another piece might be: what’s the downside of holding such a possibility as an Open Question?

        • Joseph Burgo, Ph.D. says:

          When you work with someone for 20 years, you develop a pretty clear idea as to whether sexual abuse occurred. I think in these kind of discussions, you have to accord the person who was in the room with the person doing the work a certain level of respect and trust them to know their clients better than you do. If your argument is simply “you must have missed it” then there really is no basis for further discussion. It’s impossible to disprove it.

  13. Annie says:

    Thank you for your website. I was diagnosed with BPD nearly 25 years ago and worked through my food /mother issues with my psychotherapist for many years. Recently, my sexuality/ father issues were triggered in a therapeutic context and I am now back in a transference state and working with my original psychotherapist. I’d forgotten how preoccupying a transference state is and how exhausting, and that it comes with regression. Reading your comments and those of others is a great comfort. I am grateful for your compassion. Thank you again.

    • Joseph Burgo, Ph.D. says:

      Hi Annie. Yes, it’s exhausting work, and the regression is so difficult for other people to understand. But worth going through, in the long run.

  14. Lucy says:

    Hi Dr. Burgo,

    I am so grateful for your lucid discussion of BPD on this website. I would love to hear your suggestions about my situation at your convenience.

    I have wanted to be a therapist since I was 12, and have completed a BA in Psychology with the intention of going to graduate school to study Substance Abuse Counseling. My father received a BPD diagnosis when I was 18, but he eventually dropped out of therapy, so I am familiar with the emotional environment of living with rampant BPD under one roof. I have been in therapy for 5 years, the last 3 years with a wonderful therapist with whom I developed a very strong relationship. My personal work is currently about defining boundaries, softening self-judgment, and meeting my own emotional needs.

    I am in an 8-month old relationship with a man who I deeply love and admire. I believe he fits the criteria for BPD on the lower-functioning side of the spectrum. Although he has never received a formal diagnosis, he admitted that people have “made fun of him his whole life” for his Dr. Jekyll and Mr. Hyde demeanor. He has been an alcohol and cocaine user for the last 20 years but has been sober from drugs (except marijuana) and alcohol for the last 3 months. Many old, buried feelings have been coming up for him since then, and I’m bearing a thorough tongue-lashing from him one to three times a week as a result.

    He is not seeking any type of therapy or addiction recovery support, but he’s moving ever-so-slowly in that direction. I want to hold firm in the relationship, even when he turns into Mr. Hyde, but I’m struggling with the subsequent detriment to my self-esteem. I do not historically handle hatred and anger well. It crawls under my sternum and burns there until I can cry it out. I have read every book on loving someone with BPD that the local library system has to offer, and although my new awareness has certainly helped, my resilience is wearing thin. Still, I want to do this work because the same lesson has been revealing itself to me since I was a little girl and I’m determined to resolve it. Could you please offer some phrases that I could use to help deflect his rage and protect myself? I thought it might be helpful to type a few of his frequent “assertions”:

    “You’re sick, all you do is beat me down, I don’t want you anymore.”
    “You pushed a good man too far, I’m going to get wasted and rip you apart, I’m warning you now so that everyone will say it’s your fault that you didn’t run away.”
    “You’re pathetic, you didn’t even pay for your education, and now you’re just a waitress trying to make me your little project so you feel like you have a job, go look in the mirror and work on that image, you might be standing there awhile.”
    “You unleashed the beast and now I’m going to make you wish you were never born.”
    “I’m fucked in the head, my whole life people have said I’m crazy.”
    “I’m frustrating to be around, people don’t like me.”
    “I like you, you’re a special person.”
    “I know who you are, I see you trying so hard to be with me, thank you.”
    “I’m so proud of myself for not drinking, I want to see who I become as a sober man.”
    “I don’t want to be mean to you anymore, I don’t want you to feel this way, you don’t deserve to be spoken to like that, I’m so sorry, it’s my fault.” (usually in tears)
    “I can’t believe someone’s actually sticking by my side; for the first time in my life I’m moving through the fear of abandonment and finding relief in the outcome.”

    And some phrases that I’ve found helpful:

    “Whatever you say.”
    “What can you do about how you’re feeling?”
    “I’m concerned about how you’re feeling.”
    “It’s not healthy for me to engage in this with you right now.”
    “I’m sorry to hear that.”

    Is there anything you might add? Especially phrases for deflecting rage? Is there a general emotional/facial/non-verbal “tone” I could adopt that might help? I am unclear on how to use his feelings to connect with him. If it’s the job of the therapist to help him bear with his feelings and learn to understand them, what’s my job?

    Many many thanks.
    Lucy

    • Joseph Burgo, Ph.D. says:

      Wow. My first reaction, as I began to read through his statements to you, was “What are you doing there?” By the end, I could see the goodness and I understand why you might want to remain with him.

      From my point of view, I don’t think you should feel that you have to act in a quasi-therapeutic way to help, nor should you express a kind of hollow empathy. You need to set limits.

      If it were me, I would make it clear to him that he cannot speak to you in that way. If he does, you should remove yourself from his presence. You should let him know that if he continues to behave this way over time, you will terminate the relationship. Your job is not to heal him. You can’t do that. Your job, first and foremost, is to protect yourself from abuse. Setting firm limits is the only chance you have to make a difference, for yourself and for him.

  15. Hannah says:

    Hi, I’ve just got out of a relationship with someone diagnosed with BPD. Although he claims it’s bipolar – it may be both, and also had a head injury in the past to use to excuse things like not getting out of my house when asked to at times when he was raging. The things I’ve read in books and the internet like this page this last couple of weeks are spot on, down to the expression I remember noticing on his face when I first saw him – resentful entitlement. I can see now what the problem is. And I totally recognise some of the quotes just above as the same thing that would come from him. That was about from about 5 months into the relationship, by 8 months he’d started pushing the boundaries further and was violent a couple of times, and now I’m determined to move on. I’m not someone with high self-esteem, and I tend to take responsibility for things. It can be very easy to take things to heart and think they’re true about you, especially when they resonate with other things – but when someone gets to know you they can get instincts that you feel this way and can use them against you, and also, we all have all these aspects of everything, things are not necessarily completely true or completely untrue. But so what? What matters is that no one deserves abuse. Thankfully I’m more sensible these days and have a wize mum to talk to. It’s a shame people with BPD can’t have more sympathy and compassion during their times of being abusive, and can behave in disgusting ways only to later be tearful and repentent and make you feel like you are fulfilling needs that only you can fulfil, and are with someone that loves you so much. I know in my 20s I would have stayed with him longer and had my life turned into chaos and my head turned to mush in terms of self-esteem, all my progress lost, and for what? To have that intense love he often showed, for less and less of the time, to walk on eggshells with him while all the other possibilities for me sailed away. The thing is, from the sound of it he had an okay childhood, a bit of bullying at school and his parents moving around a bit so he felt like an outsider, whereas it was me that was sexually abused from 6 to 9 and lived until I was 14 with a paedophile blocking my way into my house and calling me names until he died, had my world torn apart when I was 9 and told what had happened, and had my first boyfriend leave me after 2 years to run off with my maths teacher at school, etc, but I think I’ve turned out ok eventually, through helping myself, only to have this man try to break me down again by telling me I’m evil and everything’s my fault. So I don’t understand, why is it that some people seem to develop this tendency to be so damn nasty to other people, no matter if they’re in tears or whatever, while other people take it inside and blame themselves for everything that happens instead and feel sympathy so easily and try to do better?

    • Joseph Burgo, Ph.D. says:

      First of all, I’d be suspicious of his account of his childhood; for him to turn out the way he is, it must have been much worse than he describes it, but probably in subtle ways. He may be in denial. I don’t know how to answer your last question. It is sometimes mysterious to me, how people such as yourself, coming from truly awful backgrounds, manage to develop compassion and empathy, while others who come from much less toxic backgrounds, never do.

  16. Melinda says:

    Hello Dr. Burgo!

    I’ve been out of a relationship for a year with someone who I believed suffers with undiagnosed BPD and strong traits of entitled narcissism. He had all the traits listed in the DSM IV and seems to be textbook BPD: impulsive, raging, jealous, controlling, intensely loving, and a bottomless pit of need. Before BPD my life seemed pretty regular with the garden variety of life’s ups and downs.

    You know the mix tape: the relationship seemed like paradise on earth. Yeah I ignored red flags, and he had a couple of chinks in his chain but there was no way I was walking away from the most addictive sex in my life! I would put on my codependent cape by fixing and mending his brokenness. Then he’d forever be indebted to me and we’d live happily ever after. I wasn’t even aware that this fantasy thinking lived inside of me. I was consumed and obsessed with not losing.

    When his parasitical ways proved life threatening for me I was forced to bail. Here I am narcissistically thinking I’m God’s gift to this broken man and he treats me like crap on a stick! The push/pull became an addiction of high’s and low’s. The love phase came crashing to an abrupt halt when I realized that he didn’t understand reciprocity. This was the most devastating truth of it all: that he saw me as an object and not a person who deserved love.

    At the end; I felt like I had been dropped off the highest point of the Brooklyn Bridge. And even though I left there were times when the abandonment shame and pain was so unbearable that I wanted to crawl under a rock and die. Things ended so badly with my undiagnosed BPDex that I had to get a restraining order. I had to cut off my hand to save my arm.

    Having a year behind me in my rear view mirror and with some talk therapy I’ve been able to make connections with how this relationship came into my life to truly heal my soul. I was in severe denial about my own traumatic childhood, the PTSD I suffered from, and the affects of being raised by a depressed emotionally neglectful and shame based toxic family.

    My entire life I rationalized and covered up my shame in humor and accomplishment. My life for the most part became about proving my worth to others and in return receiving the validation, nurturing and unconditional love that my child heart so desperately craved. My BPD ex saw through my “props” and went on full terrirization mode; anything to keep me bonded.

    The relationship with my BPDex ripped off improperly healed scabs of toxic shame, emptiness, brokenness and ultimately deep sadness. So in a way this relationship has been God’s greatest gift of healing to me. I was at my bottom I had no way to look but up. God loved me enough to make me face the truth: that I was lovable, whole, complete and needed by him.

    It is very difficult to admit (especially when the world views you as successful) that you suffer with toxic shame, low-self-worth and low self-esteem. I mean…who really wants to admit that?
    But I have and it’s been liberating separate what happened to you from your actually being.

    My ex physically assaulted me, was a bottomless pit of need and an emotional replica of my mother. It was a bitter pill of truth to swallow but what an aha moment for me!

    As for healing I have confronted my mother about her emotional abuse. I have also confronted my father for abandoning me. My mother’s has been emotionally depressed for as long as I have known her and my fact is schizophrenic. I was in denial about them both. I have gotten a lot of the shame out by simply admitting the truth to myself and truly understanding that the feelings of toxic shame that I carry will not kill me.

    I’m on my way to healing and can now actually feel a sense of compassion for my ex. Having BPD is having emotional cancer. It’s a toxic state that I wouldn’t wish on my worst enemy; but I must say had I not met my ex (and I believe it was destiny) I would not have had the courage to break the family tradition of passing on toxic shame.

    I now understand & believe that the Universe is out to love and support me and that I am worthy of love simply because I was born. Things are not perfect with my mother; she is still the same shame based person but I can now see that her narcissism is a cover up for deeply embedded pain. I now surrender all things out of my control to the God of my understanding.

    I thank my creator for using me and awakening me to end the cycle of passed on toxic shame.

  17. pilgrimchild says:

    jay,
    your client reminds me of students i have had in my special ed class– i was wondering, is it possible to do a couple different things with her–
    1. make her dress herself– if she doesnt get dressed in the morning, she doesnt get to eat breakfast and has to stay in her room all day. eventually she will get really hungry, right?
    2.make her clean up her own messes, dont do it for her. she gets no therapy or food or services until she cleans up.

    maybe these things have already been done…but they just came to mind.
    i am sorry its so difficult.

  18. kate - BPD says:

    Seems that there is a distinct loathing and derision reserved just for those with BPD. I have suffered with BPD for at least 2 and a half decades and, having been in and out of many hospitals – often against my will – it always appeared to me that there was a certain censure for those of us who had BPD. It never appeared to me that those who suffered from Bi Polar or Schizophrenia or Depression or Hyper Mania or OCD, with all the adjunct difficulties, frustrations and challenges that those conditions present to the health professional, were ever treated with the contempt that BPD patients were. Years after my longest hospitalistaion – 18 months – I was (un)fortunate enough to get access to my medical notes, for legal reasons, and the entirely derogatory, supercillious and derisory language that had been used to characterise my ‘behviour’ (illness) was really alarming to me. To know, in retrospect, that those health professionals who had been charged with my care had had such an utterly debasing view of me as a patient in their care, gave me a clue as to why my treatment had been unsuccessful. If you ask the majority of BPDs or NPDs they will tell you that their ‘treatment’ felt more like a punishment. I thought it was health ‘care’. If you start from the premise that the patient is at fault then you may as well forget it. I almost wish the medical fraternity would make its mind up about Personatily Disorders, even the Multiples, and come to a consensus, so you can either decide to treat or criminalise – but not try to do both at the same time.

    • kerry says:

      Kate yes i myself got my notes and they said i was a naughty young lady that did things for attention and knew what i was doing etc that was a year ago and yesterday i went back to see a new person and they was ok with me told me i had bpd and i wish i could go back to her and tell her more but im not allowed she just diognoses people…

  19. Liz says:

    I am in recovery from BPD. I was very lucky that I saw a Schema therapist who explained BPD to me in realistic terms, and went through my whole childhood explaining how I’d ended up the way I am.

    I believe that BPD is like many dissociative states, changing from one hour to the next, depending on what triggers you. We never ‘live in the now’, we are always stuck in the traumas, seeking out people who remind us of it and acting it out. Nobody was ‘real’ to me, people were fragments of me or the abuse I’d had. Looking back at how I treated people brings me so much shame. I had no empathy or understanding that other people feel, probably because I was so numbed off from my own feelings. I had been depersonalised from childhood, living in my own dreamworld of nightmares and hallucinations.

    When I would rage, I would be ‘away’ from myself and just snap back as if nothing had happened while the other person was still reeling. I would often dissociate and self-harm, or do something dangerous. The anger came from fear, it was my armour. I dind’t have the emoitonal intelligence to be assertive of express myself properly, so I would rage instead. I had no way to express how I was feeling.

    I think most pwBPD have dissociation. Derealisation is when the world suddenly seems unfamiliar or fake, and I believe this is what causes the instability. It’s a terrifying feeling if you don’t know what it is. I would look in the mirror and not recognise my face, my clothes, my posessions, the people around me. I was desperately looking for something familiar. I would cut myself, because pain was the only tangiable and familiar thing I could think of at that time. I now have breathing grounding techniques when this happens, anchors to help being me back to myself. But when you have this chronically, it’s so scary. Imagine constantly waking up not knowing where you are, who you are. Sometimes yesterday would feel like a year ago, my memory was awful, i had huge gaps in my memory with no life timeline, and i couldnt remember my childhood. I would even have delusions that people and places were replicas.

    I punished people for loving me. Someone being nice to me would fill me with shame, it was too overwhelming, it reminded me I was worthless. So I would push people away and abuse them. Then I’d feel guilty and self-harm. This was an endless cycle, and I wound up very lonely, which is the biggest thing I feared. I would often goad my partner to abuse me, pushing them to the edge, to recreate the abuse, because that felt safe and familiar. Love scared me, but I understood being hit and shouted at. I wish more than anything that I’d never been in any relationships because it must have been extremely traumatic for the other person, i wasn’t well enough, and i put them through torture. But on the other hand, I also allowed myself to be abused. I was either the perpetrator of abuse, or I allowed it to happen. I went for controlling men, because it made me feel safe.

    I relied on others to validate me existence, literally. The dissociation made me feel I didn’t exist, and if someone left me, I felt I was floating off the end of the earth. And I would feel they were dead, I would never see them again, if they went away. It was terrifying, and I would do anything, threaten suicide, for them not to leave. I had no idea that I was experiencing dissociation- derealisation, I was processing my life with the emotional understanding of a 4 year old. I could never process ‘I am going to miss you so much, and when I don’t physically see you I feel you are dead. I feel I am never going to see you again’. I would just rage and threaten things instead. Being left on my own was unbearable, even thinking of the pain now, makes me cringe. It was like the grief of when someone dies. I would feel the other person would forget about me and leave me, and find someone better. Which they usually did, because they got so fed up with the way I was acting. I couldn’t tolerate it, and would drink to knock myself out until they came home again. I think pwBPD have an ‘out of sight out of mind’ mentality as well, I could forget about someone quite easily.

    I became addicted to drama just to feel alive. The emptiness was torture. It’s strange, because my ‘real’ personality is very quiet and shy, I was constantly embarassed by my behaviour and couldn’t understand why i was acting this way because it was so exhausting. I could never keep friends, I had very poor social skills, no boundaries, was often taken advantage of because I was so desperate for people to like me, I didn’t know who I was so I would change my personality and appearance depending on who I was with. I would become enmeshed with people very easily and lose who I was, which I dind’t mind as I loathed myself. I would copy other’s personality traits and mannerisms, sometimes not even realising.

    The ‘mood swings’ were from excessive anxiety and then slumps of depression and feeling worn out. I would get so anxious and overstimulated, not able to self-soothe, I would even hallucinate. Self-soothing was a big issue. I would drink or cut just to feel normal. The only physical attention I had as a child was through physical abuse, so I associated that with love, and used pain to soothe myself. Also, it was a way to heal myself. Cutting and then dressing the wound made me feel i was in control and being kind to myself.

    We think in black and white. I had a concrete belief that I was ‘all bad’, I was born evil. If I had a criticism, it would cut me to the core and it was overwhelming, I’d have to self-harm to deal with it, or punish myself. But the criticism was usually me perceiving it to be worse than it was. I had a concrete belief I was stupid, so any criticism would justify that to myself. I could perceive rejection in anything. When you feel ‘all bad’, it’s the most horrendous feeling. Through Mindfulness I learned that people just ‘are’, there are no ‘all good or all bad’ people, nothing is black and white. I still get episodes of being overwhelmed while triggered, but I am able to tolerate them better.

    Also, being ‘all bad’ meant I didn’t have to get angry with the people who’d abused me. It waws a form of control. Seeing myself in shades of grey, that I had some good qualities, meant I had to deal with the abuses and that I didn’t deserve it. That was the hardest part. I liked being ‘all bad’ it felt familiar.

    BPD thinking is illogical and warped, because like I said, we are thinking like children. Frightened, abused children. I think the most important thing to teach someone with BPD is grounding techniques. Also, Schema therapy is amazing for giving you an understanding of yourself. Being BPD is terrifying, I had no idea what I’d do next, what mood I would be in, who would get fed up and leave, would I lose my job, partner, be hospitalised. I found talking therapy made me worse, Schema therapy gives you boundaries and logic, which is something we lack. Talk therapy seems never ending and you go over and over things.

    People with BPD suffer with alexiythmia, not able to express or understand our emotions, so we rage like children. Acting in or acting out. We are stuck at around 4 years old, I believe, in our emotional development. I think giving someone words to express themselves is important, especially mid rage. It’s very frightening to have these overwhelming emotions and not know what they are.

    I found Mindfulenss helped a lot with distress tolerance. Because our emotions can be so engulfing and frightening, we do anything not to feel them. Mindfulenss has taught me not to be afraid of my emotions and to experience them safely, and also realise where they come from. We relive our traumas daily, and the strong emotions that come with them. I am less angry now because I have acknowledged and validated my pain, my ‘inner child’ knows she is safe and doesn’t need the anger to protect me.

    I read many books such as ‘Toxic Parents’, ‘Reinventing your Life’ etc that helpeded me. It is a great feeling to heal yourself, to get back control over yourself in a healthy way. I do Trauma Release Exercises on a daily basis, which help with anxiety and anger, they have really changed my life. I realise I will always have an abandonment and abuse schema, but I am able to not act on my fears.

  20. Jen says:

    Upon reading this account (I stumbled upon it while looking for guidance on dealing with being the primary caregiver of a relative with BPD complicated by dementia), I applaud Pilgrimchild’s response to Jay’s dilemma. I know the original comment was posted over a year ago, but I sincerely hope by now that this unruly client has either been moved to a more restrictive environment or has had boundaries set for her behavior so that she can retain the privilege of receiving care at the level she is. No matter how severe her inner turmoil, such disruptive behavior had to be contained for the welfare of the other patients as well as the staff. She was interfering with the care of all concerned.

    As an aside, I believe that Jay needs to seek treatment for PTSD himself for dealing with such a situation on a daily basis. I don’t see how anyone, no matter his/her training, could escape unscathed.

  21. kerry says:

    Jay i just found out ive got bpd… after so long being passed from piller to post maybe have this maybe have that.. and yes its very hard for me but this women is very ill at the worst stage id say ive been there once and nearlly again 2months ago but i got medication and stopped the harming me or others bit but last time i tryed killing somebody at the time i didnt know what i was doing but im glad the police got me before i got the hated person… has i had a knife which yes i got charged with.. i went into a mental hospital and wow i loved the staff but after abit i hated the staff they made me angry i felt trapped i felt everybody was laughing at me patients was to i fell for another anotther patient and when he liked the other girl i hated her and wished i was fatter like her so he liked me etc… its mad now because ino i didnt want him really .. but im thinking maybe your patient as got a crush on u an this is why she is like that as i was abused sexualy an if i guy i liked didnt like me boy did i make them pay coz i thought i was only good for being used for sex and then it confused me wen they didnt want it

  22. kerry says:

    Liz i dont know the real me i am nice caring helpful bit when im ill im nothin i dont want anybody but i do aswel i scream out like a child having a padfy and then i lose myself im gone and that other me is there i can see and hear everything she does to people but i cant stop her she laughs at my loved ones and i punch my head to stop her takin control even more i dont like her shes nasty to me and wants me to hurt myself and others ino now how to ignore her abit but its took me 5years to do that on my own.. i change my hair all the time when i feel down as it helps for abit… i get scared ill never be normal i want to be normal im cryin now its scary what i no about myself and illness but i cant stop it

  23. Ann says:

    Hello. My son is 21 years old and suffers from severe episodes of rage which he is unable to stop and usually involve destroying his or his father’s property and expressing hatred for his father or non-caucasion people. He does not seem to have a stop button and they happen almost instantaneously, are brutal verbal attacks and always blames others for his problems. I had always thought the rages are due to his severe lack of self esteem and anger directed at his father due to alcohism and porn addiction – the reason why we are no longer together – however his paternal grandmother was diagnosed with borderline personality disorder and I’m now beginning to wonder if this may also be at play in my son’s situation. He has been diagnosed with bipolar disorder and is taking Depakote, Celexa and Klonopin but is being treated by a state funded mental health facility which does not do much more than refill his meds. He abuses the Klonopin by taking 5 to 7 pills at one time, to try and stop the rages, but this is, for the most part, ineffective. He has a facination with guns and seems somewhat paranoid. I am very worried and try and talk to him when he rages about killing people who he thinks have wronged him, but he ruminates and can’t seem to move on. He is very caring and protective towards me and is remorseful if he hurts me verbally. He has never hurt anyone, just property, but fantasises about killing people who have wronged him, but says it’s just his way of venting when he talks that way and he really would not carry it through. After an episode he will cry or have a long period of tiredness, as if they have exhausted him. He has recently told me about the drugs he abused as a teenager and says he regrets that since it prevented him from being a succesfull student and participating in sports. When he gets angry at or around his father, his dad will ignore him or turn up the TV so loud so he can’t hear my son, which just esculates the problem. My son is living with his girlfriend who has very little insight in how her actions exacerbates my son’s low self esteem.

    He now appears to be goal directed since he’s decided to stop eating terrible food, lose weight and get in better shape, which will help his low self esteem. He’s also enrolled in a local tech school to get an associates degree in criminal justice and wants to be a police officer, particularly in narcotics. But is still having the rages and I fear that will affect his judgement should he ever be successful in entering law enforcement. Hopefully, he will be weeded out in the screening process, but that will result in worsening feelings of low self worth.

    He does get so angry he has talked about killng himself and I did have to call the police on one occasion when he claimed he had put a loaded gun to his head but “just to see what it would feel like” and he then put the gun down and walked out of the room. He was 1013′d to a local ER and admitted into a crisis unit for a week which he says “saved his life” but the after care has a lot left to be desired. I have not heard him make any suicidal threats recently.

    Anyway, just wanted to post this and perhaps get some feedback which might help me cope with my son. He his dearly loved by me and his sister and my mother, etc. I just don’t know what to do.

    Thank you.

    • Joseph Burgo, Ph.D. says:

      Your son is struggling with profound shame, what you’re calling low self-esteem. He needs to be in psychotherapy, probably more than once a week. The meds aren’t going to help in the long run.

  24. db2 says:

    I have to work with a large quantity of these people in the industry I work in. Many of them express themselves in damaging ways such as feces throwing, spitting, blaming, false accusations, severe reality distortion, lies, manipulation, creative and focused or planned abuse or premeditated repetitive abuse. Some are open to feedback but others are not. Most seem to be women from low-income to poverty backgrounds of all races. Many suffer low self-esteem and excessive rage, guilt, shame, etc. from traumatic stress events in their past or childhood. The behavior seems to range from mild to major with people in mid-life having the most difficulties and life disruptions.

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