Borderline Personality Disorder and Denial

I don't see anything wrong with me. It must be you.

Source: Patt Vielma/Pixabay

Many individuals with symptoms of borderline personality disorder (BPD) also suffer from a condition called anosognosia. This means that they cannot recognize their symptoms, resulting in them often denying troubling symptoms that are observable to others. Jeremiah’s story is very serious, but not uncommon.

Jeremiah’s Story

Jeremiah was a 17-year-old with symptoms of BPD. One night his father came into his room unannounced and found him cutting his arm with a razor.

Dad: What are you doing?

Jere: Nothing.

Dad: You are bleeding.

Jere: Dad, it's nothing.

Dad: How did it happen?

Jere: Can we just forget it?

Dad: No. We cannot.

Jere: I just scratch myself a little now and then. It feels good, like scratching an itch.

Dad: I think you need help.

Jere: Dad, all the kids do it. It just feels good. Nothing wrong with that.

Dad: You don’t think there is anything wrong with that?

Jere: No. You drink a beer or get a massage to feel good. I scratch my skin. Same thing.

Jeremiah’s denial that his self-mutilative behavior is a symptom, and therefore unhealthy, makes it very difficult for Dad to get his son help. If Jeremiah recognized that self-destructive behavior was unhealthy and that his continuing to engage in this behavior would make him sicker, then he would agree to his father’s offer of professional help and accept gratefully. Jeremiah’s anosognosia causes him to deny his symptoms and refuse any help as he continues to regularly engage in a potentially life-threatening behavior. This leaves his father with two options:

1. He can compel Jeremiah to speak to a mental health professional by threatening to restrict him if he does not comply. For example, he can tell Jeremiah that without checking his mental health status with a professional, he cannot get a driver’s license, go to college, etc.
2. He can try to force Jeremiah into treatment by taking him to an emergency room for treatment of his wounds and psychiatric evaluation.

Until Jeremiah is able to see that he has a problem and needs to solve it therapeutically, all that can be done is to try to prevent him from hurting himself any further. Once he acknowledges that it is a problem and agrees to participate in treatment, then he can learn healthier ways to cope with his uncomfortable feelings.

Zena’s Story

Denial in individuals with symptoms of BPD also prevents healing and growth in relationships with family and friends. In the following example, Zena is trying to bring up something that prevents her from being closer to her mother with the intention of removing the obstacle so that they could be closer and more comfortable together.

Zena: Mom, it would be nice if we were closer.

Mom: I would like that too.

Zena: It would help me if you could try not to lash out at me when we disagree.

Mom: I don’t lash out at you.

Zena: Whatever you want to call it when you yell at me.

Mom: I don’t yell at you.

Zena: Last Saturday I was 15 minutes late to meet you and you said you wish I was never born.

Mom: You were disrespectful to me. I didn’t do anything wrong.

Zena’s efforts to be closer to her mother with symptoms of BPD failed because her mother denied that she had lashed out at Zena. When Zena confronted her mother about it, she turned it back on Zena and criticized her. Zena ended up being less close to her mother due to her mother’s staunch denial of any symptoms.

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Use of Boundaries With BPD Denial

If your loved one has symptoms of BPD and they are in denial of those symptoms and you cannot tolerate their symptoms, then your best tool will be to set and maintain boundaries. The boundaries you choose should be relevant to the symptom and enforceable by you. In the first example, Dad can set the boundary with Jeremiah that he cannot be safe operating a motor vehicle until he addresses his behavior, whether he views the behavior as a symptom or not.

Zena can choose a boundary that requires her mother to address the lashing out behavior as a condition of spending more time together. The boundary should be stated clearly and respectfully. Zena’s conversation with her mother might sound like this:

Mom: Zena, why don’t you come to my home for dinner? I will make your favorite.

Zena: Before I am willing to have an evening alone with you, I need you to address your lashing out at me.

Mom: I told you I don’t know what you are talking about.

Zena: Then you should find someone you trust who can explain to you why telling your daughter “I wish you were never born” is hurtful to your child.

It is very important that Jeremiah’s dad and Zena are consistent in maintaining their boundaries. Jeremiah may initially say that he doesn’t care about driving but eventually, he will probably realize that all of his friends are getting driver’s licenses and he will give in. Similarly. Zena’s mother may initially refuse to look at her hurtful behavior towards her daughter, but if she values her relationship with Zena, she will eventually come around. If she doesn’t, then Zena will be better off with a more distant relationship.

Anosognosia, and the ensuing denial of symptoms in people who suffer from symptoms of BPD, is the biggest obstacle to their recovery from their condition. It is only when these symptoms cause them dysfunction that they address the symptoms; when they don’t get what they want. As the loved one of someone who suffers from the denial of symptoms of BPD, you might use boundary-setting as a way of preventing them from getting what they want from you until they address their symptoms. Failure to do this will enable your loved one to continue unhealthy behaviors and get sicker.