Why People with Borderline Personality Are Hostage to Shame

Who are you? In our current media culture, identity reigns. Group identities (racial, sexual, gender, political) tend to get all the attention, but to psychologists, the version of “you” that looks out on the world, and inward at yourself, is actually changing from moment to moment.

Our sense of personal identity changes in response to any number of factors, especially our emotional states. Imagine, for example, that another driver has just cut you off on the freeway. Swerving your vehicle, that momentary version of “you,” suddenly rehearsing retaliatory fantasies toward an anonymous fellow driver, is hardly an ordinary version of yourself. Thankfully, anger (especially rage) is an emotion with a short half-life; this “avenging warrior self” will likely dissipate within the next few exits.

Shame is different. No other emotion so literally and directly impacts our global sense of who we are. When experiencing shame we feel small, diminished, inadequate, and bad. In acute shame, access to positive regard, or even a coherent sense of existing or deserving to exist, may momentarily desert us.

While we all struggle with shame from time to time, research indicates that people with borderline personality disorder experience significantly increased levels of shame (but interestingly, less guilt) compared to other people. If you have been diagnosed with borderline personality disorder, or have someone with borderline traits in your life, it is useful to understand the important role of shame vulnerability in unraveling the often confusing manifestations of this disorder.

Borderline Personality and Shame

Borderline personality disorder begins by adolescence or early adulthood. It is characterized by problems with interpersonal relationships (they are intense, alternating between idealization and devaluation), mood (depression and especially inappropriate, intense anger), and unstable self-image. Current estimates of the general population prevalence of borderline personality disorder range up to 5.9 percent, and recent studies of college students suggest that up to 17 percent struggle with significant borderline traits. Borderline personality disorder is associated with psychiatric disability, substance abuse, eating disorders, and medical problems.

People with borderline personalities are subject to frequent triggers to unsettling shame experiences. These episodes can be long-lasting, severely distorting perceptions and behavior. Shame experiences at crucial periods during childhood and adolescence help cement the accumulation of a network of negative beliefs about themselves, the other people upon whom they depend, and the virtual certainty of mistreatment. Throughout life, the borderline person then continues unconsciously seeking and finding (and unwittingly provoking) confirmation of a painful, internalized sense of fundamental inadequacy, badness and victimization. Any random encounter, disappointment, memory, thought or fantasy is liable to reactivate this process. Back to the driving analogy above, the borderline feels “cut-off” by situations or other people numerous times a day without ever getting behind the wheel.

Of special concern to clinicians who treat them, borderline patients are prone to suicidal threats, gestures and attempts, as well as self-mutilating behavior such as self-cutting. They are difficult to manage. On the one hand, they often feel desperate for, and will attempt desperate measures to attain, the attention and care from which they feel chronically deprived. But at the same time, they are hyperalert to imagined disapproval or abandonment by these same caregivers.

A theme of instability pervades the borderline’s life. When treating a borderline patient, it can feel like you are dealing with several different people. From one moment to another, shifts in sense of identity and behavior are sudden and dramatic. At the beginning of a session, you might be sitting with someone who seems calm and insightful, only to find that same patient inexplicably argumentative, angry, and complaining later in the hour. They are prone to storming angrily from therapy sessions, and from treatment altogether. In this way, therapy is a window into the quality of their other relationships.

Watching the Clock

When later reviewing with a patient what led to one of these sudden eruptions, the clinician must be tactful and non-accusatory. Often, it is a descent into a lurking network of shameful, self-hating states of mind that results in the misalignment.

For example, it has long been clinical lore that a therapist should avoid even discretely glancing at the clock during a session with a borderline patient. Uniquely alert to any signs that the therapist’s attention is distracted or waning, the borderline will vehemently accuse this therapist of “not really caring” or finding the patient “boring.” On a deeper level, this ready vulnerability to a sense of abandonment is related to the triggering of mental states in which the patient is reminded of feeling empty, alone, invalidated, and unworthy of attention. In the midst of such an implosion of self-esteem and fragmentation of identity, other people, even a long-trusted therapist, become little more than caricatures of cruelly uncaring monsters.

Hiding, Blaming, Lashing Out

There are three main responses to shame installed in human nature: hiding, blaming and lashing out angrily. Despite disproportionate help-seeking (borderline personality is the most common personality disorder seen in outpatient and inpatient treatment settings), they seldom directly disclose the internal conflicts at the heart of their distress. Instead, self-injurious behavior such as cutting or suicidal preoccupation are acted out, often as a means of communicating needs for care, and conflict about receiving it. Psychic pain is thus converted to the physical and interpersonal realms. The actual nature of the emotional pain is hidden from others and only dimly understood by the patient.

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Managing Embarrassment

If you are a therapist treating borderlines, or share your life with a borderline, conflict is familiar, and blame will circulate in the air. Not only will you be deemed to blame for claimed failures of caring, but the borderline will engage in (often uncommunicated directly) internalized cycles of self-blame. It is helpful as a clinician to be aware that when a borderline patient is expressing blame or hatred toward you, the patient may actually be ridding him or herself of an immediate upswell from an undercurrent of simmering self-contempt.

The term “borderline rage” was coined by clinicians to refer to a particularly bitter, overwhelming sense of blind anger manifested by borderline patients. When feeling alone or abandoned, left with a fundamental sense of “something missing” within, the borderline may react with levels of extreme anger that will surprise and even shock you. In these states, the borderline may lose the ability to accurately discern the behavior or motives of others, instead projecting indifference or intentional cruelty. De-escalation strategies, rather than sophisticated explanations or deeper, insightful interventions, will be called for in these instances.

Developing Awareness

Perhaps the best established and researched approach to treatment of borderline personality disorder is dialectical behavior therapy (DBT), developed by Linehan (1993). A central component of DBT is the development and practice of mindfulness. In mindfulness, awareness is focused on identifying active thoughts and feelings, in the present moment, while suspending self-judgment. In the process of carefully observing, describing and participating in their immediate experiences, patients learn to identify and control destructive mental habits otherwise unexamined.

Mindfulness training is challenging but worthwhile. In my experience, when undergoing mindfulness protocols, people with borderline personalities are almost immediately struck with the level of shameful self-judgment they bring to much of their conscious and unconscious mental lives. It can initially seem overwhelming, but when slowed down and examined, many thoughts, and their emotional origins, become clearer both to the patient and therapist.

Unlike guilt, which is a frequent topic in therapy (e.g., “I don’t know whether it’s rational, but I blame myself for X and I feel Y about it and do Z as a result”) shame tends to remain a private, painful emotion seldom acknowledged even to ourselves. Once revealed in the safe presence of a trusted therapist, shameful thoughts and memories lose some of their grip on our mental states. When they initially reach treatment, borderline patients hold many grim, constricting beliefs about themselves with a certainty akin to the sense of destiny. With treatment, these beliefs become topics to explore and reconsider.