Understanding Borderline Personality Disorder

By Chaplain (Major) Donald W. EhrkeApril 10, 2015

Chaplain (Major) Donald W. Ehrke
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A senior chaplain shared incredibly useful advice many years ago. He told me, a new chaplain on active duty, "Remember that there are at least three sides to every story -- what he said, what she said, and what really happened."

I have discovered that people may not always lie, but they will always offer me their interpretation of events or their "side of the story." To be a good chaplain and counselor we need to sort through perceptions and identify reality. When truth is uncovered, chaplains can encourage changes that attain achievable goals.

Sometimes "what really happened" is concealed by a heavily skewed perception. I once counseled a couple "Dave" and "Karen." Dave was worried that his marriage was ending; he truly loved his wife of two years and couldn't understand what had gone wrong in their relationship. Karen had had an affair with another man and, although she had ended it, was not happy with Dave. She explained, "He's socially awkward and always says things to embarrass me. I'm ashamed to be with him in front of my family." She threatened to divorce Dave.

During our subsequent counseling sessions Karen often complained about her husband and his inability to "get anything right." Dave was confused and could not comprehend the cause of Karen's complaints. Initially, I trusted Karen's assessment of Dave as I searched for what had really happened in their marriage. Eventually, I appreciated that although Karen's description of her husband was completely negative, his "awkward behavior" could also be seen as completely appropriate.

Moreover, Karen's personal history clarified the nature of her opinions. Karen was the victim of childhood trauma, having been in multiple, serious automobile accidents. She had a turbulent employment history and had few friends. Although she threatened to divorce Dave, she couldn't convince herself to do so. Additionally, Karen described herself as unattractive and she frequently cut herself. Karen suffered from Borderline Personality Disorder.

Borderline Personality Disorder (BPD) is exceptionally common (affecting one person in 50) yet often misunderstood. The term "Borderline" is misleading -- the disorder lies not on the border between "healthy" and "unhealthy," but on the border between "neurotic" and "psychotic."

Perhaps the most recognizable feature of BPD is "black and white" thinking -- an inflexible and flawed method of interpreting the behavior of others. An individual with BPD may, for example, be completely enamored with a new acquaintance and describe him as her best friend. If this new "best friend" should disappoint her by breaking a lunch date, she will regard him as being untrustworthy and completely devalue the friendship. People suffering from BPD frequently misinterpret other people's intent; in the example of the broken lunch date, she couldn't entertain the possibility that she was "stood up" for legitimate, reasonable causes.

Additionally, individuals suffering from BPD typically fear abandonment and will engage in behaviors to gain attention. In the counseling scenario mentioned earlier, Karen had her bags packed and placed them by the front door -- but she could not actually leave Dave. Furthermore, she engaged in self-destruction behavior (cutting and sexual deviancy) common to BPD and demonstrated a very poor self-image -- yet another trait typical of the disorder.

Given its symptoms, it is not surprising that persons with BPD experience troubled relationships. "Black and white" thinking, extreme mood swings, fear of abandonment, and attention-seeking behaviors damage their marriages and work environments.

There are multiple methods of treating BPD. Since most people with BPD experienced childhood trauma, many chaplains employ trauma counseling (such as "EMDR" -- Eye Movement Desensitization and Reprocessing) to treat BPD. Others apply "mindfulness" therapy by asking counselees to describe another person's motivation (normally interpreted negatively) for committing an action. The chaplain accepts the answer then asks, "That might be true, but what might be another possible motivation?" In this manner, the chaplain encourages counselees to think in terms other than "black and white" by introducing them to alternative explanations. Eventually, counselees learn to question their "gut feelings" and more closely evaluate emotions before accepting them as true.

It is beneficial for chaplains to become acquainted with BPD and to recognize its symptoms. Approximately 10% of individuals seen in outpatient mental health clinics suffer from the disorder; therefore, it is likely that chaplains will encounter it.

There are always two sides to every story -- what he said and what she said. Both sides, however, may not be equally valid. Understanding BPD often draws us closer to the third side -- what really happened.

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