Tuesday, March 7, 2017

Understand the Drama Triangle. Understand BPD.

Having very often been neglected, ignored, abandoned, discounted, disclaimed, and rejected -- as well as invalidated, confused, betrayed, insulted, criticized, judged, blamed, embarrassed, humiliated, ridiculed, victimized, demonized, persecuted, picked on, dumped on, bullied, scapegoated, assaulted, (and sometimes even) molested, incested and/or otherwise violently abused -- by others upon whom they depended for survival in early life, the Grinker-Meissner Level Four, adult borderline is sometimes (not always) one of author Aaron Beck's Prisoners of Hate in the hunt for blood. (This is not true of all people with BPD, but it is very often the case in the "hair trigger" Petulant and Impulsive types of BPD.)

Many people with BPD were raised by mothers who did know how to regulate their *own* emotions, and could not show their children how to self-soothe, or worse, were the actual sources of their children's relentless fear. These borderlines cannot shake their belief that they are still going to be victimized by those to whom they must attach because it is equally terrifying to them to be alone. They are trapped by a classic double-bind in Erik Erikson's "trust" and "autonomy" stages of psychosocial development in emotional infancy or toddlerhood, and It Doesn't Feel Good

It is utterly imperative to them that they not find themselves at the bottom of the Karpman Drama Triangle. Which, of course, means that someone else will have to occupy that corner so that the borderline can experience themselves as competent, powerful and secure. Righteous anger sometimes ensues. 

I have thus far encountered over 200 people with BPD. All of them display the traits of complex post-traumatic stress disorder. For them, some components of their BPD (not all of them, by any means) represent the best coping and defense mechanisms they can come up with to defend them against threat in a hostile and/or uncaring world. For the BPD who went severely "petulant" and "impulsive" at their home base, as opposed to "self-destructive" or "discouraged," others who are codependent make perfect victims upon whom to vomit their understandable frustration and rage. 

Millon's research-based, four types of BPD is a spectrum that runs from the most extraverted and externalizing to the more introverted and internalizing. One who understands Martin Seligman's concept of "learned helplessness" and George Vaillant's list of "defense mechanisms" can also see that the same spectrum demonstrates more energized and potent defenses among Petulants and Impulsives (who prefer to occupy the two positions across the top line of the Drama Triangle because they fear abuse), and more learned helplessness among Self-destructives and Discourageds (who usually settle for the bottom corner of the Drama Triangle because they fear isolation). 


I'll try to illustrate this graphically for everyone:

Petulant . . . . . Impulsive . . . . . Self-Destructive . . . . . Discouraged
Most extraverted . . . . . . . . . . . . . . . . . . . . . . . . . . . Most intraverted
Most externalizing . . . . . . . . . . . . . . . . . . . . . . . . .Most internalizing

In addition to those categorizations, Roy Grinker originated and William Meissner developed a sort of "intensity scale" of symptoms that ran from something like "occasional" and/or "mild" through "regularly observed" and/or "moderate" to "pretty much constant" and/or "severe," though they called the two ends of their spectrum "more neurotic" and "more psychotic."

What I have observed over the past 15 years is that Petulants and Impulsives tend to congregate but get in fights with each other... while Self-Destructives (especially in the digital age of social media; one need only look at the posts on reddit's SelfHarm to see that) and Discourageds tend to hang with each other, but not with non-SDs or non-Discourageds. The problem, of course, is that -- under stress -- a SD or (more occasionally) Discouraged may "flip" to Petulant and wreck the relationship.

All that said, please do not think that the borderline is anything like conscious or mindfully aware of, or anything like at "detached choice" about, his or her character or temporary position-taking on the Drama Triangle. The Petulant-Impulsive borderline is not essentially an anti-social or a sociopath, thought they may have such traits when aroused into a defensive posture. To him or her, the whole paradigm of their lives was in-struct-ed, in-doctrine-ated, programmed, conditioned, socialized and normalized long before they were old enough to have any real grasp of what was happening. In some respects, they are automatons programmed to deal with the world through a filter of mostly unconscious paranoid projection and dire need to strike a balance between their terror of being abandoned, isolated and alone... and their relentless expectations of being used and abused yet again, just as they were as infants, toddlers, pre-schoolers and possibly well into adolescence. As fearful as they are of being alone, they are equally fearful of being abused, and that is one very powerful and frightening double-bind.

Aside from personal observation, the experts I learned a lot of this from are listed at the end of this article.

It seems to me that the best thing one can do to "manage" a relationship with a borderline is to understand what is described above, as well as in Bockian's, Chapman & Gratz's and Friedel's books for people with BPD and their intimates, as well as look into...

1) The Patterns & Characteristics of Codependence on the Codependents Anonymous website;

2) "The Five Stages of Recovery" at pairadocks.blogspot.com to see where one is in them;

3) The "Karpman Drama Triangle" schematic of avoidance and control strategies in interpersonal relationships;

4) Codependents Anonymous and Emotions Anonymous meetings (you can find meeting locators on their websites);

5) "Jiddu Krishnamurti on Loneliness vs. Being Alone" at pairadocks.blogspot.com, further quoting Krishnamurti at his best on being alone vs. being lonely;

6) Practicing some thought questioner & mindfulness inducer like the "10 StEPs of Emotion Processing" at pairadocks.blogspot.com, so that one is able to continue to sense what is going on and know what to do about it;

7) Pia Mellody's book, Facing Codependence;

8) Anne Wilson Schaef's book, Co-Dependence: Misunderstood, Mistreated;

9) Barry & Jane Weinhold's book, Breaking Free of the Codependency Trap;

10) "The StEPs to Freedom from Emotional Blackmail" at pairadocks.blogspot.com, and Susan Forward's book, Emotional Blackmail on manipulative relationships;

11) Patricia Evans's book, Controlling People on the same topic;

12) Pia Mellody's book, Facing Love Addiction, especially with respect to the flip flop from addiction to avoidance;

13) Anne Wilson Schaef's book, Escape from Intimacy on the same topic;

14) Barry & Jane Weinhold's book, Flight from Intimacy on the same topic;

15) DBT's "FAST" boundary-setting skills set (on DBTSelfHelp.com).

Related Articles:

Teasing out the BSDs from BPD.

Resources

Berger, M. D., ed.: Beyond the double bind: Communication and family systems, theories, and techniques with schizophrenics, New York: Bruner/Mazel, 1978. 

Briere, J.: Therapy for Adults Molested as Children: Beyond Survival (2nd Ed.), New York: Springer, 1996.

Chapman, A.; Gratz, K.: The Borderline Personality Disorder Survival Guide: Everything You Need to Know About Living with BPD, Oakland CA: New Harbinger, 2007.

Clarkin, J.; Lenzenweger, M.: Major Theories of Personality Disorder, New York: The Guilford Press, 1996.

Clarkin, J.; Yeomans, F.; Kernberg, O.: Transference-Focused Psychotherapy for Borderline Personality Disorder: A Clinical Guide, 1st Ed., Arlington, VA: American Psychiatric Publishing, 2015.

Friedel, R.: Borderline Personality Disorder Demystified: An Essential Guide for Understanding and Living with BPD, Cambridge, MA: De Capo Press, 2004.

Gabbard, G.; Wilkinson, S.: Management of Countertransference with Borderline Patients, Washington, DC: American Psychiatric Press, 1994.

Gabbard, G.; Bossert, S.: Psychotherapies for Borderline Personality Disorder Work… Slowly, in Clinical Psychiatry News Digital Network, April 2011.

Grinker, R.; Werble, B.; et al: The Borderline Syndrome: A Behavioral Study of Ego Functions, New York: Basic Books, 1968.

Gunderson, J.: Borderline Personality Disorder, New York: American Psychiatric Publishing, 1984. 

Herman, J. L.: Trauma and Recovery, New York: Basic Books, 1992.

Kernberg, O.: Severe Personality Disorders: Psychotherapeutic Strategies, New Haven, CT: Yale University Press, 1977.

Levine, P.: In An Unspoken Voice: How the Body Releases Trauma and Restores Goodness, Berkeley, CA: North Atlantic Books, 2010.

Linehan, M.: Cognitive–Behavioral Treatment of Borderline Personality Disorder, New York: Guilford Press, 1993.

Livesley, W. J.: Practical Management of Personality Disorder, New York: Guilford Press, 2003.

Masterson, J.: The Narcissistic and Borderline Disorders, New York: Bruner/Mazel, 1981.

Masterson, J. (editor/author): The Personality Disorders Through the Lens of Attachment Theory and the Neurobiologic Development of the Self, Phoenix, AZ: Zeig, Tucker & Theisen, 2004.

McCormack, C.: Treating Borderline States in Marriage: Dealing with Oppositionalism, Ruthless Aggression, and Severe Resistance, Northvale, New Jersey: Jason Aaronson, 2000.

Meissner, W.: The Borderline Spectrum: Differential Diagnosis and Developmental Issues, New York: Jason Aronson, 1984.

Meissner, W.: Treatment of Patients in the Borderline Spectrum, New York: Jason Aronson, 1988.

Miller, A.: For Your Own Good: Hidden Cruelty in Child Rearing and the Roots of Violence, London: Farrar, Straus & Giroux, 1979, 1983.

Miller, A.: Prisoners of Childhood / The Drama of the Gifted Child, New York: Basic Books, 1979, 1996.

Miller, A.: Thou Shalt Not Be Aware: Society’s Betrayal of the Child, London: Farrar, Straus & Giroux, 1981, 1984, 1998. 

Miller, A.: Breaking Down the Walls of Silence, New York: Dutton/Penguin, 1991.

Millon, T.; Grossman, S.; Meagher, S., Millon, C., Everly, G.: Personality Guided Therapy, New York: John Wiley & Sons, 1999.  

Millon, T.; Grossman, S.: Moderating Severe Personality Disorders: A Personalized Psychotherapy Approach, New York: John Wiley & Sons, 2007.    

Negrao, C.; Bonanno, G.; et al: Shame, Humiliation and Childhood Sexual Abuse: Distinct Contributions and Emotional Coherence, in Child Maltreatment, Vol. 10, No. 4, November 2005.

Ogden, P.; Minton, K.: Trauma and the Body: A Sensorimotor Approach to Psychotherapy, New York: W. W. Norton, 2006.

Ogden, P.; Fisher, J.: Sensorimotor Psychotherapy: Interventions for Trauma and Attachment, New York: W. W. Norton, 2015.

Paris, J.: Treatment of Borderline Personality Disorder, New York: Guilford Press, 2008.

Perry, B.: Incubated in Terror: Neurodevelopmental Factors in the Cycle of Violence, in Osovsky, J. (ed.): Children, Youth and Violence: The Search for Solutions, New York: Guilford Press, 1997.

Perry, B.; Szalavitz, M.: The Boy Who was Raised as a Dog…, New York: Basic Books, 2007.

Preston, J.: Integrative Treatment for the Borderline Personality Disorder, Oakland: New Harbinger, 2006.

Roth, K.; Friedman, F.: Surviving a Borderline Parent: How to Heal Your Childhood Wounds & Build Trust, Boundaries & Self-Esteem, Oakland, CA: New Harbinger, 2003.

Russell, D.: The Secret Trauma: Incest in the Lives of Girls and Women, New York: Basic Books, 1986.

Schore, A.: Affect Dysregulation and Disorders of the Self, New York: W. W. Norton & Company, 2003.

Searles, H.: The Effort to Drive the Other Person Crazy -- An Element in the Aetiology and Psychotherapy of Schizophrenia, in British Journal of Medical Psychology, Vol. 32, No. 1, March 1959.

Searles, H.: Countertransference and Related Subjects: Selected Papers, Madison, CT: International University Press, 1979, 1999.

Searles, H.: My Work with Borderline Patients, New York: Jason Aronson, 1986.

Stone, M.: Abnormalities of Personality Within and Beyond the Realm of Treatment, New York: W. W. Norton, 1993.

US Dept. of Health and Human Services: In Focus: Understanding the Effects of Maltreatment on Early Brain Development, Washington, DC: US Government Printing Office, 2001.

Vachon, D.; Krueger, R.; et al: Assessment of the harmful psychiatric and behavioral effects of different forms of child maltreatment, in JAMA Psychiatry, Vol. 72, No. 11, November 2015.

Vaillant, G.: Ego Mechanisms of Defense: A Guide for Clinicians and Researchers, 1st Ed., Arlington, VA: American Psychiatric Publishing, 1992.

Van der Hart, O.; Brown, P.; and Van der Kolk, B.: Pierre Janet’s Treatment of Traumatic Stress, in Journal of Traumatic Stress, Vol. 2, No. 4, 1989. 

Van der Hart, O.; Friedman, B.: A Reader's Guide To Pierre Janet: A Neglected Intellectual Heritage, in Dissociation, Vol. 2, No. 1, 1989.

Van der Hart, O.; Horst, R.: The Dissociation Theory of Pierre Janet, in Journal of Traumatic Stress, Vol. 2, No. 4, 1989.

Van der Kolk, B.: The Compulsion to Repeat the Trauma: Re-enactment, Re-victimization, and Masochism, in Psychiatric Clinics of North America, Vol. 12, No. 2, 1989.

Van der Kolk, B.; Hopper, J.; Osterman, J.: Exploring the Nature of Traumatic Memory:  Combining Clinical Knowledge with Laboratory Methods; in Journal of Aggression, Maltreatment & Trauma, Vol. 4, No. 2, 2001.

Van der Kolk, B: Traumatic Stress: The Effects of Overwhelming Experience on Mind, Body and Society, New York: Guilford Press, 1996 / 2007.

Van der Kolk, B: The Body Keeps the Score: Brain, Mind, and Body in the Healing of Trauma, New York: Viking Press, 2014.

Van der Kolk, B.: Commentary: The devastating effects of ignoring child maltreatment in psychiatry – a commentary on Teicher and Samson 2016, in Journal of Child Psychology and Psychiatry, Vol. 57, No. 3, March 2016.

Vedel, E.; Emmelkamp, P.: Psychological treatments for borderline personality disorder: Are all treatments equal or are some treatments more equal than others?, in Journal of Personality and Mental Health, Vol. 4, 2010.

Vignarajah, B.; Links, P.: The clinical significance of co-morbid post-traumatic stress disorder and borderline personality disorder: Case study and literature review; in Journal of Personality & Mental Health, Vol. 3, No. 3, July 2009.

Walsh, K.: National prevalence of posttraumatic stress disorder among sexually revictimized adolescent, college and household-residing women, in Archives of General Psychiatry, Vol. 69, No.9. September 2012.

Watts-English, T.; Fortson, B.; DeBellis, M.; et al: The Psychobiology of Maltreatment in Childhood, in Journal of Social Issues, Vol. 62, No. 4, 2006.

Widom, C.: Posttraumatic stress disorder in abused and neglected children grown up, in American Journal of Psychiatry, Vol. 156, 1999.

Woititz, J. G.: Adult Children of Alcoholics, Pompano Beach. FL: Health Communications, 1983.

Woititz, J. G.; Garner, A.: Life Skills for Adult Children of Alcoholics, Pompano Beach, FL: Health Communications, 1990.

Wood, M.; Balduf, J.; Howard, K.; Huang, H.; Marino, P.; McConky, K.: Reactive Attachment Disorder: A Disorder of Attachment or of Temperament? Unpublished but peer-reviewed manuscript at http://www.personalityresearch.org/papers/wood.html, Rochester, NY: Rochester Institute of Technology, 2003-2005.

Zimbardo, P.: The Lucifer Effect: Understanding How Good People Turn Evil, New York: Random House, 2007.

© 2017 by Rodger Garrett; all rights reserved. Links are permitted. Please contact not.moses@outlook.com with comments or questions. Thank you.

2 comments:

  1. Rodger:

    I used to make a habit in 2002-03 of reading Helen's BPD site and also the Hoover/Land of Oz stories.

    And 200! That is probably 190 more than the average person would admit knowing - not counting all the people with BPD traits.

    Theodore Millon seems to be big on Wikipedia.

    ReplyDelete