Borderline Personality Disorder and Emotions

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People with BPD experience emotions more intensely and for longer periods than others. In many cases, negative emotions from the past resurge in their consciousness in a repetitive and intrusive manner. This can cause a lot of distraction and dissociation and makes it more difficult for them to achieve emotional balance. People with BPD not only experience emotions in an extreme way but they lack the coping mechanisms and strategies to regulate and mitigate these emotions. 

Emotional Instability

The fact that people with BPD experience emotions with great intensity can have positive and negative effects. On the one hand, they can feel intense love, joy and care about other people, which helps nurture their relationships and make them adorable and sympathetic. On the other hand, they can experience intense grief, shame, embarrassment and rage, which can be really difficult for others to handle. This happens because people with BPD have a general emotional instability and immaturity and face great difficulty in their effort to control and process their feelings. 

Shutting down emotions

Sometimes after emotional outbursts people with BPD can feel extremely ashamed of themselves. In order to face this shame they try to shut down their feelings completely. This can be a quite problematic strategy because negative emotions can be a warning sign for problematic situations in our life that help us find solutions and avoid difficult circumstances. Blocking the entire range of emotions can be a great problem in handling the everyday relationships and taking the right decisions.

Dysphoria

Last but not least, people with BPD are prone to intense feelings of dysphoria (feelings of mental and emotional distress). Researchers have identified four types of dysphoria that are typical to people with BPD 1) extreme emotions that are difficult to handle (as mentioned above) 2) destructiveness or self- destructiveness 3) feeling fragmented or lacking identity and 4) feeling victimized. These feelings of dysphoria intensify the lack of identity that so many people with BPD experience and make it more difficult for them to handle their relationships. 

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Introduction to Borderline Personality Disorder

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Borderline Personality Disorder is a personality disorder which is characterized by difficulty in regulating emotions, instability in relationships and a problematic sense of the self. People with this disorder have difficulty understanding and expressing their emotions, they cannot easily invest in relationships with others and live with a fragmented sense of the self.

People with BPD experience intense fears of abandonment, anger and irritability that come to surface unexpectedly and are difficult to understand. These symptoms usually originate from traumatic experiences in childhood, which remained unexplained and unprocessed. All these experiences were so overwhelming that left a permanent influence on the person’s character.

Furthermore, people with Borderline Personality Disorder are quite sensitive to the emotional reactions of other people and they tend to respond impulsively and with anger before they clear out the others' intentions. This often leads to misunderstandings that are usually left unexplained and unresolved.

People with BPD often idealize and devalue other people in an extreme way. They change abruptly their opinions about others from admiration to disappointment, which makes it quite difficult for them to form mature relationships. Instead they create fragile and volatile bonds that are easily disrupted. This happens because people with Borderline Personality Disorder cannot perceive others as complete beings with positive and negative characteristics. They split their perceptions and create fragmented relationships.

Apart from that, when people with Borderline Personality Disorder face the possibility of rejection or loss they react with increased impulsivity and unstable behaviors. Since they don’t have a stable sense of the self that would help them process their emotions, they behave without thinking and they usually burst out their feelings to family, friends and coworkers. This creates a lot of stress to the people who live around BPD patients.

The above feelings and behaviors of the Borderline Personality Disorder are persistent, inflexible and mark the person’s life throughout a variety of contexts. Usually the symptoms of BPD start from adolescence or early adulthood and continue throughout the life span. However, some psychologists claim that we can identify a personality disorder even from late childhood. Similar to most personality disorders, once BPD is established it becomes an integral part of the person’s character and is very difficult to change. 

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The Psychosomatic Personality Structure

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Joyce McDougall (1920 -2011) was a psychoanalyst who worked throughout her career with psychosomatic patients. Through her accumulated clinical experience McDougall developed the idea of the Psychosomatic Personality Structure. She argued that psychosomatic patients have a character structure  which is characterized by lack of emotions, wishes and internal conflicts and a quite mechanical way of thinking. These characteristics make the psychosomatic patient quite different from the psychotic or neurotic patient.

Main Characteristics

The psychosomatic patient often uses a language that lacks emotional words and develops relationships with little or no emotional investment. This happens because the psychosomatic patient has excluded a whole range of emotions from their lives and this makes it difficult for them to fully relate with other people. Psychosomatic patients also don't exhibit neurotic symptoms like depression, phobia and hysteria that can be more easily discussed and processed in therapy and instead of that they develop somatic symptoms. Last but not least, many times therapists who treat psychosomatic patients see physical pain where one would expect negative feelings. For example, in the case of loss and separation many psychosomatic patients instead of experiencing sadness, anger or desperation they start having stomach or chest pains.

  
Psychosomatic Illness vs Hysteria

McDougall further differentiated psychosomatic illness from hysteria. She argued that in hysteria the body lends itself to the mind in order for the emotional conflicts to be expressed whereas in psychosomatic illness the body seems to have its own processes divided from the mind. The drama enacted in psychosomatic illness is more archaic and the way symptoms are created is different. In hysteria the links between body and mind are repressed and unconscious but they are still there. In psychosomatic illness the links between body and mind are completely broken because the mind has suffered such a great damage that has detached itself from the body. It is as if psychosomatic patients suffer an internal death of emotions.

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Regression of the Psychosomatic Patient

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Severe regression of the psychosomatic patient happens in three situations. The first situation is when separation or death of a loved person is imminent. In this case the psychosomatic patient cannot process their grief and they develop somatic symptoms. McDougal, a very famous psychoanalyst, noted that many of her patients who faced a potential separation instead of letting themselves experience their sadness they developed physical symptoms.

The second case of severe regression happens when the partner of the psychosomatic patient exhibits characteristics that are not expected and cannot be enclosed in the relationship. For example, when the partner wants to distance themselves or expresses beliefs and emotions that are not anticipated. This happens because the new personality characteristics create cognitive dissonance that leads to stress.

The third case happens when the patient has invested in two different people who argue and have serious differences with each other. This causes internal conflict which has its roots in the Oedipus complex of the childhood years. Young children experience great stress when their parents argue because they feel caught in the middle. The psychosomatic patients are sensitive to these situations and can sometimes reproduce them in their adult life.

In all of the above three situations the psychosomatic symptoms cause somatic pain which paradoxically is more endurable than the psychological pain. At the same time the psychosomatic symptoms become a defense that protects the self from further disorganization. It is as if the somatic symptom takes the place of a psychological defense mechanism that is not there. In the cases of severe regression the somatic symptom deteriorates and can last for longer periods of time.   

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Somatization and Essential Depression

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The idea of essential depression was introduced by P. Marty in his 1966 article “La depression essentielle” and became central in the theory of psychosomatics. The term suggests a kind of depression which is not caused by the loss of a loved person but a depression related to more archaic phases of development.

Marty suggested that essential depression is not characterized by sadness or pain but by a lack of desire. Patients with this kind of depression feel tired and empty. They don’t complain about anything and they don’t seem to have emotions or fantasies. They remain motionless, unmotivated and with no desire for life. This is why essential depression is also called “white depression” or “depression without an object”.

Essential depression is further characterized by a reduction of the libido invested in other people (object libido) or the self (narcissistic libido). Patients with essential depression don’t seek the company of other people and lack the desire to create bonds. They remain secluded to themselves in an isolated world and they communicate only through their body symptoms. 

According to P. Marty the absence of emotional bonds, the flattened emotion and the breaking down of mental processes, which are all symptoms of essential depression, are also characteristics of alexithymia. Alexithymia is a mental condition in which the patient cannot access their own feelings. The more the patient cannot bring into words their feelings the more the somatic symptoms deteriorate. If this situation persists, emotional disorganization becomes more severe leading to the somatization of the symptoms and the gradual disorganization of the whole body.

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Psychosomatic Symptoms - The Allergic Object Relationship

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P. Marty elaborated on his theory of psychosomatic symptoms in his 1958 article called “The allergic object relationship”. In this article he suggested that psychosomatic patients suffering from allergies, especially asthma and eczema, display a special relationship pattern. This pattern is characterized by their need to merge with other people and identify with their characteristics.

According to Marty this process of merging has two phases. Firstly, psychosomatic patients project their own qualities to the other person and secondly identify themselves with the qualities that they have projected. Through this two-fold process of projection and identification they have the delusion of becoming one with the others.

The merging of the subject with the other person is at the beginning forceful and violent but later becomes smoother. The psychosomatic patient is very eager to find people who are susceptible to this kind of control and are willing to be “objectified”. This usually happens because they have a very weak and inconsistent ego structure and they try to control other people in order to overcome this vulnerability.

This way of relating of the psychosomatic patient originates from early infancy. At that age the mother – child relationship is built mainly on touching and holding. If this relationship is not safe, the infant cannot create a stable initial representation of the self. This makes it difficult for the baby to make sense of their internal feelings. In these cases the infant creates a shell that protects but also hinders the self from connecting to other people. The somatic symptoms developed in adulthood reflect this poor self- organization.

Marty showed the validity of his theory by bringing up clinical material from his work with psychosomatic patients. Some of them said: “I am so dependent on you…I am you”, “I cannot live within myself but only united with another person”. Even in the first psychoanalytic interviews patients made slips of tongue like “I am here because you suffer from eczema” or “You certainly wish me to tell you about your mother'”, which reflected their lack of boundaries in the therapeutic relationship and their instant identification with the therapist.

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