The ninth diagnostic criterion of BPD, according to the DSM-IV, is “transient, stress-related paranoid ideation or severe dissociative symptoms.”
Triggered by episodes of stress, BPD patients will often harbor beliefs that they are “being harassed or persecuted, or beliefs involving general suspiciousness about others’ motives or intent.” During such times, accusations about a partner’s infidelity often arise “– all despite overwhelming objective evidence to the contrary,” explains Helen’s BPD Resources. The BPD patient may even believe that a loved one may be trying to poison or otherwise harm him.
Dissociation is “an unexpected partial or complete disruption of the normal integration of a person’s conscious or psychological functioning.” In extreme cases of dissociation, the borderline will have no memory of an incident, usually involving one of his rages, at all. In most cases however, he will rescript his memory of the event, responding not to the current situation, but to a past trauma, Helen’s BPD Resources states. Because of this, borderlines tend to be oblivious to the effect their rage has on others.
My job as a teacher on an Indian reservation was extremely stressful, and it didn’t take much to trigger borderline behavior and borderline thinking. I did believe that my wife had affairs, especially during the first few years of our marriage. I had no concrete evidence to support that belief, only what I perceived to be suspicious behaviors. Consequently, I dug deeply to find anything that could incriminate her. I even installed a keylogger program so I could read her emails.
I believed it impossible to have a rational discussion with my wife. No matter how calm and rational I was in my own estimation, she would be evasive, withdraw, and eventually cry. It took an eye-opening counseling session during one of my hospitalizations that made me realize I was continuously badgering and threatening her. During that session I managed to maintain my composure somewhat. I was not a screaming maniac as I had often been before.
One time, I was behaving so boorishly that my wife went upstairs, crying. Her son came downstairs and suggested I apologize to her. Instead of listening to this very reasonable, mature request, I flew off the handle, screamed at him as well, and attempted to send him to his room.
Another time, my rage sent my wife upstairs again, and her kids were desperately trying to console her. I went after her, shouting that it was inexcusable to drag her kids into a disagreement between the two of us. What I did not realize was that I was shouting. What I did not realize was that it is inexcusable to drive one’s spouse to tears.
The underlying thread in both examples is this: during these rages I dissociated, rescripted the memory of the event, believing myself to be calm, collected, rational. I believed it was my wife who was behaving irrationally, even hysterical, when it was I who was out of control.
I believe it is this criterion that renders borderline patients to resistant to treatment. It blinds them to reason. Attempting to give the patient ownership of his illness means giving him responsibility he may not be able to handle. Even the suggestion that he needs to reevaluate his own responses and perceptions can easily be misconstrued as an attack on the patient’s self image. But I believe it is possible for any patient to reach a moment of awareness, a point where he can safely draw the distinction between his illness and his identity.