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In my last post, I described impaired ability to cope with frustration as the emotional driver of lashing out behavior in individuals with symptoms of Borderline Personality Disorder (BPD). In this blog, I will discuss cognitive/perceptual factors associated with BPD that contribute to the frustration and hence the acting out. Individuals with symptoms of BPD often see and think about things differently.
Black-and-White or Binary Thinking
Many individuals with symptoms of BPD tend to see the world in extreme qualities. For example, others are seen as either good or bad and treated accordingly. Things happen either always or never. Every conflict must resolve with one person being right and one person being wrong. The inability to see shades of grey often causes them to see things in distorted terms, which adds to their frustration. Consider the following exchange in which Josephine’s father is frustrating her by not giving her what she wants when she wants it.
Josie: Dad can you give me a ride to the mall?
Dad: Yes. I will be free at 4.
Josie: I need to go now.
Dad: Why? The stores are open until 8.
Josie: My friends are there now.
Dad: I have to finish some business calls before I leave the house.
Josie: Can’t you make your calls after you take me?
Dad: Josie, I have to do my work first.
Josie: You always say no to me.
Dad: I am not saying no to you.
Josie: You always put yourself before me. You are a horrible father.
The above dialogue has several examples of black-and-white thinking. Josie accuses her father of always saying no to her, always putting himself first, and being a horrible father because he didn’t drop what he was doing and take her to the mall right away. She sees her father as not willing to help her ever when he has offered his help but she would have to wait until her father finished what he was doing. She then feels justified lashing out at him.
Self-Referencing
Individuals with symptoms of BPD often see things as being about them that have nothing to do with them. This is another type of cognitive/perceptual distortion. In the following example of self-referencing, Chase perceives his brother taking a new job and relocating as a personal rejection, while Sydney’s decision to relocate had nothing to do with Chase.
Syd: Chase, I got a fantastic job offer. I will be making twice my current salary, plus a bonus.
Chase: I am happy for you.
Syd: But the job requires that I relocate to the West Coast.
Chase: You mean you are leaving me?
Syd: I am not leaving you; I am taking advantage of a fantastic career opportunity.
Chase: But you are leaving me. Like a worthless piece of trash. Haven’t I been a good brother?
Syd: Of course, you have been a good brother. This is a work promotion.
Chase: Just go. Why should you care? I don’t want to be your lousy brother anyway.
In the above dialogue, Sydney explains to Chase that he is moving for his career but Chase hears it as a personal rejection, which is distortion. Although the move affects him, it is not about him. It is about Sydney following his career. Instead of convincing Sydney to be closer to him, Chase pushed him away.
Listening Bias
To understand what somebody is communicating, you need to listen to them. Optimally, you approach the communication wanting to hear what the person is trying to say to you. Individuals with symptoms of BPD often listen for certain facts or messages in what is being said to them. Rather than enhancing communication, listening for generally misdirects the communication away from the intended subject.
In the example below, Greg is trying to communicate with Doris about plans for Christmas. Doris is insecure about feeling welcome and so she is listening for rejection or lack of sincerity.
Greg: Let’s firm up our plans for Christmas Day.
Doris: I thought we already had plans. Did you change your mind?
Greg: No, I just wanted confirm the time.
Doris: I figured I would come the night before so I don’t have to travel on Christmas Day.
Greg: We hadn’t discussed your spending the night.
Doris: OK. Whatever. I don’t need to be with you on Christmas.
Greg: I am trying to make plans with you.
Doris: Forget it. It is obvious that you don’t want me there.
In the above example, Doris begins the exchange with Greg looking for signs of rejection. She does not hear that he has initiated a conversation with her for the purpose of coordinating the event, and then she turns into a self-fulfilling prophecy. This increases her frustration and then she lashes out.
Three types of cognitive/perceptual distortion that are often found in individuals with symptoms of BPD are described above. All of them increase the individual’s frustration, which increases the chance that they will lash out. Individuals who suffer this type of response to frustration will benefit from taking a dual approach towards healing and growth:
- Address the cognitive/perceptual distortions described above by recognizing these patterns and compensating for the distortion.
- Increase your tolerance for frustration in order to lengthen your fuse. This involves increased monitoring of frustration level and taking steps to reduce stimulation when near threshold. This means taking breaks from conversations before getting overwhelmed by frustration.
Cognitive Behavior Therapy (CBT), including Dialectical Behavior Therapy (DBT), can be helpful in achieving these goals. Persistent efforts in these areas will likely yield significant improvement in interpersonal relationships and increase the stability of close relationships.
