Working With Families & Young Adults With Borderline Personality Disorder (BPD) – Part II

The Strategy of Compromise: Achieving the Most Favorable Outcome for Young Adults with BPD and their Families

Why is it more difficult for young adults with Borderline Personality Traits or Borderline Personality Disorder (BPD) to compromise and make decisions?

There are many factors that may help explain it.

Extreme Sensitivity

Many believe that the nervous system of those with BPD is exquisitely sensitive to emotional stimuli. Therefore, they may experience their emotions or stressors more intensely.

In his article in “Psychiatric Times” (May 2012), Blaise Aguirre, MD, suggests that our understanding of Borderline Personality Disorder is “progressing from a strictly psychodynamically based construct to a neurodevelopmental disorder with roots in the genetics of the child, the child’s temperament and the environment.” Dr. Aguirre is assistant professor of psychiatry and Medical Director of the Adolescent DBT Center at McLean Hospital in Belmont, MA.

If this is so, then perhaps a neurologic imbalance can amplify anxiety, which may then alter perceptions of available options and choices. The young adult easily may experience a sense of being emotionally overwhelmed. Minor glitches or changes may be viewed as catastrophic. Understandably, they may react more intensely to the ambiguity and complexity of decision making.

At our OPI Intensive for young adults 17-28 with BPD, we notice that even simple choices can be viewed as being extremely difficult. When asked a relatively simple question, the answer may be, “I don’t know!”

Black and White Thinking

There is always a certain amount of anxiety associated with decision making. At some point, most parents ask their young adult, “What do you really want to do with your life?”

This can be a far more complex and overwhelming question than one might think, especially for those with BPD who, understandably, have an intolerance for ambiguity and ambivalence and therefore the gray areas in life.

In order to deal with this, many develop a coping or anxiety management style that yields only two options when answering these kinds of questions:

• Right /Wrong
• Black /White
• Perfect or Chaos

After all, this black-and-white thinking style is the most efficient way for us to bring our anxiety to zero and justify the anger we feel at being out of control.

But only seeing and experiencing the world through a black/white lens impairs one’s ability to satisfactorily adapt to changing circumstances. One becomes less able to acknowledge the ambiguity of relationships and the world. It gets harder to see the other person’s “point of view.” It makes compromise and negotiation progressively more difficult. AND, it creates a sense of isolation, alienation, impaired esteem and greater insecurity because it becomes progressively more difficult to succeed at longer range goals.

The natural process of growth is up-and-down, back-and-forth. When each change is experienced as catastrophic, it is hard to incrementally build upon successes. Therefore, many with Borderline Personality Disorder are unable to achieve their own goals even though they may be bright and gifted.

Complexity of Life: Happiness in Imperfection, Not Perfection

The challenge for these emerging adults is to learn to appreciate the complexity of life. They must begin to deal more effectively with the imperfections in themselves and in others and the world so they can begin to understand and appreciate that happiness is found in imperfection not perfection.

There are no “perfect” decisions, just “optimal” decisions based on the reality of the present moment. All of us need to learn to take our best shot, to take skillful action based on a “faith” or “belief” that things can work out, versus the fear of catastrophe and loss of control if perfect outcomes are not achieved.

This need for control and perfection can create an atmosphere within the family of frustration, mistrust and polarization.

In order to break the cycle of alienation and suffering for these young adults as well as their families, we must gain a greater understanding and appreciation of:

• How these young adults with BPD see the world
• Their defenses and thinking styles when dealing with anxiety
• How they limit their world and create intense suffering for themselves and families.

For additional information about families and BPD, read the other articles in my series on Working With Families & Young Adults With Borderline Personality Disorder (BPD).