The Aging Borderline Personality Disorder Sufferer
Previously we have looked at the story of Kerri, who suffers from borderline personality disorder (BPD) as well as Anna, who was the daughter of a sufferer of this condition.
Today, we will be looking at the aging BPD sufferer, because although the criteria for a clinical diagnosis remains the same for all ages, the ways in which this disorder manifests can change over time as the sufferer ages.
The criteria for borderline personality disorder are listed below. Five of the nine criteria must be met before a positive diagnosis can be made:
- Displays an abnormal fear of abandonment.
- Displays an unstable pattern of intense personal relationships which alternate between extreme liking (or loving) and extreme devaluation and belittlement of the people with whom they interact.
- Identity problems: a marked and persistently unstable self image and sense of self.
- Displays impulsivity in at least two of the following areas: overspending, sex, substance abuse, reckless driving, binge eating. The person places themselves willingly into physical harm’s way (including subtle means, such as substance abuse, smoking, etc, which is slow, but nevertheless harmful).
- Displays recurrent suicidal behavior, self mutilates or expresses suicidal gestures?
- Displays marked mood swings which are not drug or alcohol related, such as depressive behavior, anxiety, or irritability which lasts a few hours but rarely more than a few days.
- Displays chronic feelings of emptiness.
- Displays inappropriate intense anger, or has difficulty controlling anger (eg. frequent displays of temper, constant anger, recurrent physical fights).
- Shows signs of paranoia when under stress.
Bearing this in mind, let’s look at the case of Lyn, a 66 year old woman who suffers from borderline personality disorder. Lyn does not display the physical self mutilation that forms one aspect of the diagnostic criteria but one that is overemphasized in fiction and film and thus associated strongly with BPD.
However, Lyn is an extremely impulsive person and indulges in binge eating, and impulse buying to a point where she is out of control. Lyn will call into a supermarket and buy a packet of chocolate biscuits and go to a friend’s house and consume the lot within ten to fifteen minutes, even though the biscuits were purportedly bought to have with a cup of coffee with her friend. If she doesn’t finish the packet completely, she asks if she can leave it at her friend’s place because, if she takes it home, she won’t be able to stop herself from eating the remainder. Thus she makes other people responsible for her own lack of self control over food.
She also has a similar problem with candy, so much so that at the age of 66 she cannot stop herself eating but again asks her friends can she leave what little remains of her purchase at their house. This is because if she takes the object in question home, she freely admits she will sit up for the rest of the night and eat the remainder. She admits to binge eating in her own home as well, indicating that she just “can’t stop”, whilst at the same time maintaining a strict vegetarian diet. Lyn likes to identify herself with vegetarianism and a healthy lifestyle, but her inner turmoil means she cannot sustain the regime she upholds.
Lyn also has problems with impulse buying and thus has chronic money problems. She has been unable to hold down a regular paying job even though she has a bachelor’s degree and is overqualified for many of the casual jobs she has acquired and subsequently left over the years. She is unable to apply herself to full time work even though she has the qualifications. She admits she has “wasted her life” and fels a sense of emptiness that she has done so. However, she does nothing to change the situation, and given her university qualifications, she would have easily found a well paying job when she was younger.
Lyn will often come up with unusual schemes about which she believes she wants to do and which are believed by people who do not know her well. One week she will state that she wants to go to Africa to help the starving children. Being physically fit, she believes she can do this but never follows through, not even looking at how she can help the plight of children in Africa from within her own country. The following week, it will be another scheme. After a while, most of Lyn’s acquaintances learn to shut off and do not get involved with her ideas which never materialize.
In terms of her lack of control in several areas of her life, particularly food, stuffing oneself physically is a sign of emotional emptiness, another characteristic of BPD. And Lyn’s life is empty. Her husband left her for another woman when Lyn was 39 and that second relationship of her husband’s is still intact. Lyn has never been able to “re-establish herself” as she terms it, after a period of 27 years. She also struggles with personal relationships with her two sisters and is estranged from her only brother, who lives in an adjacent suburb.
Lyn also has difficulties with her three adult daughters, and there are regular screaming matches and fights between Lyn and each of her daughters. Her eldest daughter left home while still at school to go and live with her father, yet Lyn blames her ex-husband for “breaking up the family”. The reality is that no school-aged girl would willingly leave her mother and sisters unless there was a problem at home. Lyn has a very tenuous relationship with this particular daughter and almost appears frightened of her. Lyn’s low self esteem means that she tries to keep the relationship with her eldest daughter alive, but instead finds herself used by the daughter, as the latter knows she has the upper hand. This daughter treats her mother poorly, which in turn exacerbates Lyn’s’ self esteem issues.
Lyn’s middle daughter has emotional problems of her own and has threatened suicide several times. On one of these occasions, the daughter’s therapist phoned Lyn twice to tell her of the severity of the situation and that suicide was a possibility. Lyn went away on a trip for several days as she couldn’t handle the responsibility of being around for her ill daughter. This in turn had the effect of turning her second daughter away from Lyn even further and their relationship is extremely frail.
Lyn herself cannot cope with even a minor cold, and she tells people that she is “quite ill” when she has one and is straight to the doctor requesting antibiotics. Lyn is very healthy, but suffers from hypochondria. Hence every sneeze or sniffle becomes “the flu” and a brief head pain results in statements such as “I have a brain tumor, I’m sure”. As Lyn regularly declares she is psychic, she sees these signs as portents of her impending death. She is unable to soothe herself, which is one of the hallmarks of BPD.
Dramatizing everything, Lyn moves from one illness to another and worries excessively about the normal colds that her eldest daughter’s young children pick up. Extremely suggestible, Lyn believes every health fear going round and foolishly continues to share them with her daughters who are fed up with her interference and hence more arguments ensue. Lyn has never learned to respect other people’s personal boundaries. Again, the problem with boundaries and respecting her adult daughters and other family members is illustrative of her disorder. When her offers of help are rejected, Lyn crumbles. And then the brief anger period will insue.
Lyn also has marked problems with her self image. As she ages, she constantly compares herself to other women. But these women are usually 10-15 years younger than her and naturally they display less signs of aging than her. Instead of comparing herself with her peer group, she devalues her skin and general appearance via this practice. The fact that she obsessively compares to her looks to others to a point where it interferes with her life and happiness is another sign of her emotional instability.
Within her own peer group, she also has an unstable sense of self, and compares herself unfavorably to others. She regularly pulls her facial and neck skin upwards in a pointless attempt to defy gravity. This constant action only brings attention to the parts of her body which she is most uncomfortable with. At the same time, she berates others who have “had work done”.
Like many sufferers of BPD, Lyn can be fun and playful, but if she feels threatened she quickly displays her displeasure. This usually takes the form of sulking or being passive-aggressive.
Lyn also has an unrealistic and child-like attitude towards the inevitable. She refuses to consider the option of putting her name down for an aged care facility, claiming she “couldn’t stand it”. Instead she claims she would prefer to live out her days on a park bench if she ever was unable to live in rented accommodation. Yet, paradoxically, she lives in fear of being asked to leave her rented home. Each time the landlord initiates improvements, she perceives that as a sign that he will sell the property and she will be on the streets. This is followed by a round of binge eating and erratic spending.
Lyn is also easily influenced, and will take up any activity that one of her acquaintances is doing until another hobby comes along. She seldom finishes anything but complains about being unable to “have the space” to do so. She has no dependents and lives alone in a roomy apartment and is on a benefit payment so doesn’t; have to work but cannot find the time to do her painting, read her books, or restore her furniture. Her schemes change on a weekly basis.
When confronted with truths about which she is uncomfortable, Lyn displays anger which is far beyond what is appropriate for the situation at hand. At 66, Lyn still stamps her feet like a small child when she finds she has talked or lied her way into a corner. Lyn has not learned to deal with her childhood rage in an adult way. While that anger is always there, her mood is generally bright and these episodes seldom last for more than a day or two at the most. However, they simmer for another time and place.
One of Lyn’s life problems is that neither of her parents showed much interest in her. She was one of five children, all closely spaced, but unfortunately she was the second born to an older sister, who appears to have dominated Lyn and treated her with some disdain as a child. Lyn spent much of her childhood trying to be friends with her big sister, but this sister had her own friends and little interest in Lyn. Lyn still carries the scars of this rejection. Her mother was a self-centered woman, who was fascinated by her appearance and spent more time flirting with men than meeting the needs of any of her children.
Lyn also suffers from paranoia, even when she is not particularly under stress. She promotes many conspiracy theories, has a morbid interest in other people’s lives, and is quite adamant about her erratic belief systems. For example, she fundamentally believes that cage eggs are fertilized and that intelligence is transmitted through the female genes only. Anyone unwise enough to argue with her then becomes a target for her anger. Lyn cannot tolerate anyone challenging her, particularly if that person is younger than her. While the latter is normal among elderly people, the level of Lyn’s paranoia is not.
Hence it is possible to go from being Lyn’s best friend in the morning to becoming her bitter enemy by the afternoon, (in her mind only – the other person if often unaware of the rapid mood swings) merely on the basis of having a different opinion. If she is shown to actually be incorrect by an undisputable source, Lyn will ultimately accept it, but becomes passive-aggressive. However, the next time you meet her, she will be all smiles as though nothing had happened. Because of this latter behavior, people gradually become wary of her as her moods are so unpredictable. Hence, she alternates between liking and admiration to disliking and debasing. This behavior has been apparent all her adult life.
An excellent example of Lyn’s paranoia concerns a part-time workplace incident where she was asked to come in an hour later as she was not required for her full shift. When she arrived at the place of employment, she noticed the car of another worker was parked in the car park. Lyn immediately assumed that this worker had been given the hour that was taken off her. She was so angry that she confessed to her employer that “when I saw X’s car, I was ready to turn around and go home”. The reality was that Worker X was doing an independent job that was unknown to Lyn. However, Lyn’s paranoia had taken over to the point that she accused her employer of giving her hours to another worker. This was delivered via shouting and again, the stamping of the feet, behavior unacceptable to most employers. Lyn lost her job that morning because of her immature behavior fuelled by her paranoia. This was not the first time Lyn had lost a position in this manner.
And yet, despite this, Lyn can be fun to be with and a good friend at times. However, she does have boundary problems whereby with increasing familiarity she believes she has the right to apply her own beliefs over others. This causes a lot of pain to Lyn, as she genuinely doesn’t know why she is offending people, almost on a daily basis once she knows them well. With other, more distant people, she can appear quite normal. However, screaming and stomping with people with whom she feels comfortable and are rejecting her are other indicators of the illness. Lyn can’t handle rejection, or rather, she handles it by having what we would recognize readily in an angry two year old. She has a tantrum. Not surprisingly, despite her age, Lyn has no real friends.
What can be done for Lyn? Unlike the case of Kerri, who was younger,
it is harder to deal with Lyn’s problem because it is so firmly
entrenched. Lyn actually is unaware she has a problem. The latter becomes
a problem in itself as she is unlikely to seek help unless her family
encourages her to have therapy with a view of having better family relationships.
An experienced psychologist can assist in making relationships easier
for sufferers of BPD and their families. However, the problem can never
be completely resolved because the personality itself is affected, and
the person cannot be changed into a fully-functioning individual because
of the all-encompassing affect that personality disorders of all types
have on the person concerned. But certainly learning ways to better
deal with BPD sufferers can make the lives of family and friends easier
if strong boundaries are set and some allowances are made to accommodate
the fact that the ill person can be interacted with in a more productive