Is she Borderline or just being abused?

Too often the battered woman is diagnosed with Borderline Personality Disorder when she seeks out professional help.  There is nothing quite as damaging as being labelled a borderline by mental health professionals, as these are most often the difficult cases and ones that get tossed around like hot potatoes.

I’ve met true Borderlines whose symptoms become very apparent in their relationship with me and their inability to cooperate with the simplest of boundaries.

And I’ve also met many abused women who have been diagnosed as Borderline because in their fight for survival they seem to portray many of the criteria for the disorder by people who don’t understand that this is their way of staying alive, of fighting back, and of finding a way out.

The consequences of a Borderline diagnosis may sometimes be very damaging:  Doubt on the part of professionals as to the truthfulness of their story, used as a weapon by batterer, threat of losing children in court, and a lowered self-esteem which is already damaged by the battering.

I will look at the criteria for BPD and try to explain why these symptoms appear in a battered woman and why they do not necessarily mean that this diagnosis is correct:

1.  Frantic efforts to avoid real or perceived abandonment.

If it takes a woman an average of seven attempts to actually leave a batterer this pattern appears to fit the criteria. The problem is that unless she has a really good plan she may have to attempt several time and come back when threatened in order to learn what tactics he will use and to come up with ways to keeps herself safe.  Like smoking, it takes practice to get it right and the threats may be quite real.  Unless she has a habit of this behavior in other relationships, even non-abusive ones, this doesn’t fit a persistent life-long pattern and is therefore not a personality disorder.

2.  A pattern of unstable and intense relationships characterized by alternating between extremes of idealization and devaluation.

The pattern within an abusive relationship may be one of  what looks like idealization in order to keep the threat of harm to herself, children, or pets to a minimum by appearing to worship him and then devaluation when she tells her story to get support from resources.  Then she may return to him when she realizes how trapped she is and appear to idealize him again.  She pretends in order to stay safe and while she has some hope that he might change, she is watching the cycle of violence and waiting for her next opportunity.  A personality disorder, on the other hand, means that she does this with almost or all of her relationships, not just this one.  Even a relationship with a therapist.  

3.  Identity disturbance: markedly and persistent unstable self-image or sense of self.

This can be caused by battering.  Think of this as being a prisoner-of-war and forgetting who you are.  A personality disorder must be a lifelong pattern, not just a result of being battered or a period of transition in life.

4.  Impulsivity in at least two areas that are potentially self-damaging.

What do prisoners-of-war do?  They take control of the small things they can control.  Battered women may drink to self-medicate.  They may reach out to other men for comfort.  Being trapped is not an easy place to be and after finding freedom it may take a while to adjust.  Once again, one time is not a pattern.  A personality disorder is a long time way of being in the world.

5.  Recurrent suicidal behavior.

Trapped, controlled, beaten, low self-esteem caused by emotional abuse.  Who wouldn’t think of suicide?  After she leaves he might come up with a tactic of telling others that she is suicidal in order to find her, get the children from her, or have other people “watch” her.  She’s probably at a low point in her life even after leaving:  facing poverty, continuing to be harassed, feeling unsafe, having PTSD.  Is this a consequence of continued harassment?  Or a lifelong issue?

6.  Affective instability due to a marked reactivity of mood.

Anxiety?  Hell yes.  Depression?  Having to wash her face and put dinner on the table with a smile or face the consequences of continued battering?  Her life has come down to pretending to be fine when inside she wants to cry.  Even after leaving it takes a while to relearn how to live.  How to feel that it’s okay not to manage other people’s moods.  How to show anger.  

7.  Chronic feelings of emptiness.

She just sacrificed her whole life to have her freedom back.  How would you feel?  Also, the entire focus was on keeping him happy and now that that’s gone she has to find things to fill up that space.

8.  Inappropriate intense anger.

Or a PTSD panic attack caused by a trigger.  Always being on guard has left her ready to jump at any second.  And she’s angry anyway.  All the anger she has suppressed in order to stay safe may explode now that she’s safe.  Even before leaving, a person can only suppress for so long.  

9.  Transient, stress related paranoia or severe dissociative symptoms.

She may be paranoid about continued battering or entering a new relationship and dissociation is a symptom of severe PTSD.  

The questions to ask are:  Is this a lifelong pattern or is she having these behaviors while still in or having just left an abusive relationship?  Is she this way in other non-abusive relationships.  Even if she is still in contact with him, she may be pretending in order to find out what he’s up to.    This does not mean she is Borderline.  It’s a survival technique called Keep Your Enemy Close.

I had 7 out of the 9 symptoms myself (maybe more if I was truly honest) the last 2 years of my marriage when things were really bad.  Some of them were caused by daily abuse.  Some were ways I kept my sanity.  Has anyone ever thought that I was a Borderline?  NO!

If you are an abused woman and you are looking for professional help please find someone who has experience in this area and don’t stay with one who makes you feel worse about yourself.  Shopping around is just fine.

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