Borderline Personality Disorder and the Double Bind

A primary characteristic of borderline personality disorder (BPD) is the struggle to maintain consistent connections to others and to oneself. Indeed, two of the defining characteristics of BPD as described in the DSM 5 are: “Identity disturbance…unstable self-image…” and “A pattern of unstable and intense interpersonal relationships characterized by alternating between extremes of idealization and devaluation.” This volatility leads to communication patterns that have been described as double bind (1) and result in the self-defeating behavior that contributes to the agony of living with BPD.

Double-bind communication was first described as a (now mostly debunked) theory for the development of schizophrenia (2). The so-called “schizophrenogenic” mother elicited contradictory messages to the child, who subsequently developed the disorder. Individuals suffering with BPD often emit contradictory messages, putting the partner in a no-win, damned-if-you-do/ damned-if-you-don’t dilemma. This results in alienation from others and themselves. In BPD double-bind communication may take many forms:

A patient in couple’s therapy complains, “You never hug me.” But when the partner tries to embrace her, she withdraws from the gesture, exclaiming, “Ouch! You hug too tight.”

A borderline individual in the throes of a new relationship silently expects the new partner to continue to call daily. But when a day is missed, that individual becomes frightened that he has been abandoned and fear mutates into righteous anger. He excoriates his new love with accusations that push the partner away, resulting in the outcome that the person with BPD feared the most.

When Laurie confessed to her girlfriend that Laurie’s boyfriend was cheating and physically abusing her, she placed her girlfriend in the no-win portal. If the friend tried to reassure Laurie that things would work out and she should try to maintain the relationship, she could be accused of not really caring about Laurie’s suffering. If she encouraged Laurie to reevaluate the association, she would be criticized for not understanding how deeply in love she is and how much her boyfriend needs her. Laurie may later tell the boyfriend about her friend’s advice to step away from the relationship, which would result in his insistence that Laurie no longer be with her.

Even the title of this blog (also the title of one of my books) exemplifies the contradictory messages of BPD—I Hate You, Don’t Leave Me. The tragedy of living with BPD is that double-bind messages lead to outcomes that the individual is desperately trying to avoid. The DSM criteria that define BPD exhibit the contradictions that torment those with the disorder. “Inappropriate, intense anger,” “Impulsivity…potentially self-damaging,” “Affective instability due to a marked reactivity of mood,” and “Transient, stress-related paranoid ideation or severe dissociative symptoms” are BPD symptoms that alienate people. These behaviors result in the very experiences and symptoms the BPD individual is trying to avert as described in the DSM defining criteria: “Abandonment,” “Chronic feelings of emptiness,” and mood instability (“intense episodic dysphoria, irritability, or anxiety”).

Double-bind communication can also hinder the therapeutic dynamic. The patient’s spoken and unspoken expectations of the therapist may be frustrated resulting in transference distortions that interfere with the process. The therapist is challenged to preserve equanimity and constancy in order to maintain trust in the face of contradictory behaviors. Understanding how double-bind communication interferes with so many factors in a borderline person’s life is a major step toward calming the desperate storms in his life.