Toxic People Part II

Please read the article “Difficult People” on the web site first!  It is important to understand that we all have functional and even dysfunctional personality traits, and at various levels of toxicity:  You cannot diagnose yourself or someone else as having a Personality Disorder unless you are a properly trained, licensed and experienced clinician [like a psychiatrist or clinical psychologist].

In Part I we looked at Antisocial and Narcissistic Personalities:  the causes of their defense mechanisms, the nature of the defenses and the effects on other people.  In Part II we will briefly highlight Borderline and Histrionic Personality Disorders.

Borderline Personality Disorder [BPD]

One of the best books about BPD that I’ve come across is titled Stop Walking ON Eggshells!  This really encapsulates the effects of the Borderline personality on others – in that you have to be extremely careful as anything you say or do may be construed as a rejection of them or an attack on them.  By the way, I recommend this book to people who suffer from borderline Traits, and to their partners.  It’s written in comfortable lay language and incorporates also such useful insights as revealed by transcripts of internet information groups’ communications, in which Borderline personalities and their partners freely participate.

An insightful description of the Borderline state [by one of my lecturers long ago] is that the person takes in the Good, but then feels that it has become Poisonous, and has to Get Rid of it.  [And there is a degree of correlation between Borderline functioning and Bulimic functioning.]  BP’s are thus in constant need for reassurance that the relationship or situation is still Good, that they are not being rejected or attacked or betrayed or lied to, or about to be rejected, etc etc…

They also watch critically or any signs of such rejection or abandonment and tend to project the fears of what may happen as actual occurrences, on significant others.  If I dream my friend has gossiped about me, I may investigate the possibility, or wonder what in me made me dream such content, but the BP tends to immediately act out on the dream as if it’s reality, and will, or instance, strangle the partner while s/he is still asleep, for “having done” the betrayal. 

For the BP there are no grey areas:  you are either completely For them or you have Betrayed them and are an Enemy.  You cannot risk having a different point of view about anything, admiring any one else even briefly [e.g. saying you like a recording by a singer – any singer of the same gender, or any singer at all, if the BP either sings or wishes s/he could], suggest that someone else’s actions may not be as evilly motivated as the BP has stated they were…   They split the world into two groups: Those who are Against Me, and those who – at the moment - are On My Side and who have to keep proving it every second, but especially during one of my frequent Tests of their Unconditional Loyalty.  And the BP can be so charming, loving and engaging while desperately trying to create and maintain the Those On My Side group that just about any kind of person can become ensnarled in the Borderline net.

Hence the “Walking on Eggshells” analogy:  this fascinating and engaging person chooses to be with me and to be protected by me, and since s/he trusts so few, it means I’m special, so now I become extraordinarily careful not to lose him/her or cause the inevitable rejection/s [the forgive and reject cycle can repeat endlessly].

BPs tend to quickly put people who have attractive and desirable qualities [in their eyes or according to their needs] on a pedestal – which is part of their attractiveness, because the recipient of their favour is treated with adoration and attention, and we all respond favourably to that.  But when s/he inevitably fails at some stage to meet increasingly higher demands for devotion and for tolerance of invasive and disruptive Borderline traits, not only is s/he cast off the pedestal but also re-defined of being cruel, selfish, nasty, untruthful, not committed enough, etc.

Typical of Borderline traits are:

-          Continual instability of emotions [frequent and unpredictable mood swings];

-          Continual instability of relationships, with extreme idealization and then devaluation of the same person;

-          Continual instability of self-image; lack or repeated loss of sense of self;

-          Continual impulsivity – generally, or associated with acts that actually or potentially harm the self, such as spending, sec, driving recklessly, using banned substances or drinking too much, binge eating;

-          Self-mutilating [e.g. cutting self on thighs or arms, etc] and frequent suicidal behaviours, attempts, threats or gestures;

-          Frantic attempts to prevent abandonment and rejection [real or imagined];

-          Chronic feelings of emptiness;

-          Irritability and constant or frequent displays of rage;

-          “Micro-psychotic Episodes” like sudden and brief periods or paranoid thinking;

-          Dissociative episodes [feeling uninvolved or that ”This is not really happening”], especially with heightened stress;

-          Projecting previous traumatic intention and behaviours of people in previous relationships onto the present one/s.

Remember that anyone can have some of these traits in mild, moderate or severe concentration, without being fully Borderline Personality Disorder, and that the Disorder cannot be diagnosed before early adulthood.  Specifically keep in mind that many of the traits also occur as a cluster in, for instance, Posttraumatic or Acute Traumatic Stress Disorder, without the person having the spectrum of Borderline traits.  Also not that – as with Antisocial and Narcissistic Personality Disorder formation, the likelihood of underlying trauma in the form of physical, emotional or [frequent in BPD] sexual abuse is high.

I do not have enough years to describe the effect of these traits, especially when frequent and florid, on close relationships – with colleagues, friends or romantic partners.  The terror of abandonment by anyone but especially by people who are special enough to be selected as “close” is experienced as suggestive that the BP is “bad”, and that can’t be tolerated:  For the infant abandonment means death, so BPs may try to restore previously discontinued relationships for even many decades after the “loss”, while re-playing the script that makes it possible to blame the one who “left” them for the problems, never the self.  What starts as surprise or confusion for the partner or friend, ends in torture of recriminations and approach-reproach cycles that can repeat endlessly even when there are new objects of affection available.

Relationally [and therapeutically] what is necessary for the BP to begin to heal is consistency, very strong boundaries, and repeated proof that the partner cannot be destroyed by the “poison inside” of the “bad” BP.  And probably the resilience and skin of a rhino – for the attacks are chronic, unpredictable, irrational, and the demands for rescue are heart-rending.

While therapists have immense empathy for people with such strong and disruptive defensive structures as they understand the massive injuries to the early formation of he Self that cause them, and can set boundaries and stay consistent, therapists do not have to live 24-7 with the symptoms.  People who do, are almost always overwhelmed by the exhausting and disrupting nature of the interactions over time.  People with strong Borderline traits or BPD should be helped to engage in appropriate therapy so that they can be free, over time, from the hurts and the damaging defenses against the pain.  This is not a disorder that can be managed by self-help techniques and there is also a significant danger that in group types of therapy that are not very carefully managed by clinical experts, the sufferer of such traits may collapse psychically, or succeed [sometimes accidentally] in destroying the self.

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Histrionic Personality Disorder [HPD]

Defining metaphors: “Over The Top!”, “Drama Queen”, “Melodramatic”.

If one were to write text for a Histrionic Personality [HP] in a play, one would run out of exclamation points, and probably out of highly emotive and excessively passionate adjectives and adverbs.  No, even nouns and verbs would be carefully selected to make much ado about very little, everything aimed at focussing the attention of anyone, everyone and everything [pets and cameras definitely count] solely on the HP.  And should the attention be called away for a moment or even lapse [as when the baby actually falls asleep while the caregiver needs it to stare adoringly], the attention-demanding behaviours, attitudes or emotional expressions escalate, to greater flamboyance, loudness or unexpectedness. 

There is usually little fact or reason that underlies strong and dramatic expressions of opinion of the HP, and hyperbolic speech is the norm.  Negative events are catastrophised [“It was horrific to sit in that awful traffic for so many hours; it ruined my whole day!” = 10 minutes in mild traffic]; others’ striking qualities are minimised, and own achievements greatly enhanced or embellished.

While such persons can be amusing or even attractive to bystanders for short periods of time, they tend to wear out the capacity for giving constant attention and adoration of people in closer relationships very quickly.  They also tend to be insensitive to snubs or ignoring, and have no respect for others’ needs for personal space, quiet, or consideration.  People who are legally caught up in necessary continued close contact [in business, for instance, or in marriage] usually have one of two options of response, neither of which seems to have any effect on the pervasive pattern of histrionic behaviours:  either flattery and fake, public adoration [as the Director supplied to the movie star] or avoidance, with clever snide remarks that can be misconstrued as compliment [as seen in several of Jane Austin’s characters].

Typical traits are:

-          Excessive emotional expression and constant need to be the centre of everyone’s attention;

-          Inappropriate sexual or provocative behaviour in social contact;

-          Superficial but dramatic emotionality, with rapid shifts in expression and kind;

-          Use of physical appearance to draw attention to the self;

-          Elaborate and embellished style of speech, with little underlying substance;

-          Over-dramatic, theatrical and exaggerated expression of emotion and description;

-          External-directed: Easily influenced by others or by circumstances;

-          Interprets relationships as closer or more intimate than they are in reality.

HPs typically lack the introspective ability, insight and motivation for change required in therapeutic journeys.  It seems they either find a niche where they can be accepted or tolerated, or move in circles where superficial expression is the norm.

Persons with sufficient intellect and hurt of failed relationships may be willing to modify over-dramatic and attention-seeking behaviours while also understanding that it is a disturbance and not a talent to act in such self-absorbed ways.

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         - Please also see article on “Toxic People” on this web site

Unfortunately it is true that every one of us – even the most saintly – has some character traits that irritate some other people!  The good news is that it’s not always the fault of the person who is perceived to be irritating:  for instance, a “Type A Personality” may benefit from having some traits of more peaceful and joyful people that s/he finds highly annoying because they may not behave rashly enough to suit his/her needs for immediate gratification.  So, the person described as “difficult” may not be as problematic interpersonally as the one who describes him/her in such terms.Traits are considered to be dysfunctional if they interfere significantly with our optimal functioning in our personal life [e.g. causing depression, anxiety, addictions], our social life [e.g. our ability to function effectively socially or in intimate or family relationships], or our work life [e.g. in concentration, or in relationships at work].

Character or personality traits are qualities we all have, in various combinations.  They can be adaptive or functional, like certain life skills:  An accountant needs to be precise in her work, but hopefully not in exact in the way she arranges her flowers every day.  That would be bordering on maladaptive or dysfunctional behaviour, and may be traits or indicative of a fixed and invasive Personality Disorder which generally can affect people around her negatively or lead to arguments or rejection.

Traits are called ego-syntonic if we are proud of them and wish to keep them, despite others not believing we should indulge in them, or despite their interference with our optimal functioning as described above [e.g. "I like being aggressive: it gets me what I want"].  Traits that we ourselves recognise as dysfunctional or negative are termed ego-dystonic [e.g. "I would like to stop being addicted to cocaine because I realise it's harming me and my family"].

Certain clusters of traits appear to occur in set patterns and are always dysfunctional. These clusters are diagnosed only in adults [i.e. people over 20] and are well researched so that reasonably accurate conclusions can be drawn as to their causes and how they affect an individual and his/her life.  We can even predict with reasonable validity when a teenager who displays these clusters is likely to develop them into the fixed patterns of behaviour called Personality Disorders, by the time s/he reaches adulthood.

Although a person must fulfil all the criteria to be diagnosed with a Personality Disorder [and only a professional with clinical certification, like a psychiatrist or a clinical psychologist, may make such diagnoses!], some adults have enough of the traits to make their or others’ lives a misery – hence “difficult people”.

The following PDs [Personality Disorders] are stipulated in the current Diagnostic and Statistical Manual of the Psychiatric Disorders [DSM].  There are also other proposed categories [e.g. Depressive PD] that are being researched and may be added later.

CLUSTER A                                     CLUSTER B                         CLUSTER C

PARANOID PD                                ANTISOCIAL PD                 AVOIDANT PD

SCHIZOID PD                                  BORDERLINE PD                DEPENDENT PD

SCHIZOTYPAL PD                          HISTRIONIC PD                  OBSESSIVE-COMPULSIVE PD

                                                       NARCISSISTIC PD              PD NOS [Not Otherwise Specified]

Personality traits are not chosen as an act of will, and they are not signs of “madness”, though they may make people feel “mad, bad, or sad” if the traits are strong! [with prevalence of the traits notated as ++ or +++].  “Madness” [or psychosis] implies that an individual is frequently and grossly out of touch with reality, and no longer generally able to function effectively in his/her life - personally, socially or occupationally.  Even persons with “text book” PDs, tend to function quite well in some of these areas most of the time, and – except for Antisocial PDs – are usually not hospitalised or institutionalised [eg in forensic settings] – unless there is a specific symptom or threat such as attempted suicide.

Even for certifiable “madness” [psychosis – see below], there is always a Cause or Etiology.  The old psychotherapy cliché “It’s all my mother’s fault” is not as inappropriate as most of us would prefer it to be, especially if we are a parent or a caregiver! But the failure to make an individual feel safe and wanted in the world is often caused by peers, or by other authority figures or caregivers than the mother.  

Defense / Coping mechanisms are the infant’s and the young child’s attempt to ward off perceived terror / anxiety in repeated early situations that suggest to the person that s/he is in danger of abandonment / rejection / annihilation that would end in the destruction of the integrity of the Self.  Such defense mechanisms are not “genetic”, although symptoms could be similar: Being born with brain damage, for instance, may predispose a person to act out violently, similar to someone with Antisocial PD, or to have severe mood swings like someone with Borderline PD;  however, the cluster of symptoms and etiology is what allows us to differentiate between various mental disorders, according to a Differential Diagnosis.

Other disorders now clearly associated with brain damage [eg low brain matter density and resultant enlarged ventricles] include psychotic disorders, like the schizophrenias [typically demonstrating symptoms like auditory hallucinations or various delusions], and these may be aggravated by inadequate parenting. 

“Psychotic / psychosis” implies an inability to stay primarily in objective reality.  We might all like to call our mother-in-law or boss a “Devil”, but when we actually believe her/him to be Beelzebub, horns and tail and pit of sulphur and all, we are diagnosed as “psychotic”.  Psychosis may usually be indicated in any of three categories: 

[1] Not being orientated to Person [who I am], Place [where I am], Time [when is this] or Situation [what is happening]. 

[2] Hallucinations [seeing or hearing or smelling or tasting or feeling things that are not there as if they are, or vice versa, not experiencing them when they are present], or Illusions [experiencing distortions in sensory perceptions, such as “walls bending in on me”]. 

[3] Delusions [fixed beliefs that are not real to objective others, eg "I can fly off the roof", or "There is a snake in my belly and it's eating me up inside"].  Note that such psychotic symptoms are commonly associated with people who do not have a general psychotic illness but who are intoxicated by drugs, and they can also occur in certain cultural milieu such as “mass hysteria” and a “calling to be a spiritual healer”, without indicating a fixed psychotic disorder.

NB: Note that psychiatric disorders are diagnosed according to an Exclusion principle, i.e. first eliminate possible medical causes of symptoms, then possible substance causes, then genetic, etc…   And diagnoses are based on patterns or clusters of symptoms, not on a single symptom.  [This means, Gents, that a woman who is pregnant and has mood swings because her hormones are not balanced, may NOT primarily be diagnosed as "Borderline" because of the one symptom;  it is however possible to be both Borderline PD and pregnant.]

While people with PDs may have certain symptoms that appear delusional [such as the belief "I am the greatest person on earth and therefore deserve special treatment" in Narcissism, or "I am helpless and can't do anything for myself" in Dependent PD] or hallucinatory [such as the body dysmorphia associated with some eating disorders], the person with a PD moves generally in the world of objective reality, with short lapses into unreality [often described as micropsychotic episodes] from which s/he can usually emerge without medication or any overt intervention.

PDs are resistant to therapy:  How can one be expected easily to give up the very habit/s one unconsciously believes are the only defense that wards off one’s annihilation?  For the first part of the 20^th century Freud and his followers generally de-selected people for analysis if they suffered serious deficits such as found in the PDs.  Even in face-to-face psychoanalytic therapy it could take many years of thrice or twice a week therapy for the PD to abate sufficiently for people to live more peacefully with others and themselves.  Speedier results have been reported with modern integrated therapies that include techniques like Hypnosis or EMDR, but the danger of causing collapse if the defenses are too quickly overwhelmed, is significant, and such work should only be attempted by licensed and experienced or supervised clinical psychotherapists.

Remember that PDs are formed after repeated and continuous failures of caregivers to provide a safe, accepting, welcoming, non-intrusive yet stimulating, caring environment, with appropriate freedom and boundaries, over time.  And none of us are taught this art in schools!  We learn our parenting skills from the often inadequate role-modelling by our own parents, early teachers and other caregivers.  And if there is a severe enough failure to provide such a safe and nurturing environment by even one “big person” [such as being emotionally abused by a teacher or sexually molested by a family member], not even the best efforts of relatively good parents may be sufficient to ward off severe defensive traits or even disorders of the personality.

Half a century ago British psychoanalyst Donald W Winnicott coined the phrase “good-enough mother”, which can be extrapolated to good-enough parents, father, nanny, teacher, etc.  Different behaviours are required of good-enough parents in the child’s different developmental stages [for instance, not still breastfeeding the seventeen year old may be a good idea].  An infant psychologically needs a great deal more eye contact and physical holding than a teenager, as another instance.  Modern psychotherapists generally believe that optimal provision of a child’s emotional needs should include unconditional love / positive regard, freedom from intrusion and neglect, and appropriate boundary setting for his/her behaviour, and some add optimal frustration, which stretches his/her resourcefulness without being overwhelming.

When parents / significant others repeatedly fail in one or more of these areas, the child is likely to develop such strong defenses against unconscious fears of being hurt / annihilated / abandoned / rejected, that the formation of a PD defensive structure is likely.

So, generally “difficult” people can become “nicer” people if they get a chance to have these basic developmental needs consistently met at some stage in their life, for instance in therapy.  In interaction it nay be useful to remember that the “difficult” behaviour in any specific moment points to a fear of a perceived threat:  If Alex suddenly becomes bombastic / grandiose/ arrogant, it’s likely that someone has done something [or Alex believes in fantasy  that this has been done!] to make her/him feel small, powerless, disrespected, ignored, diminished, worthless, unheard… [for instance, in ignoring his/her contribution to a discussion].

The answer to the question of how to change his/her defensive behaviour seems obvious:  to acknowledge that s/he is worth some positive regard.  Similarly, if Ashley is acting in an over-controlling manner, it is likely that more structure or safeguards are necessary in the situation/s that evoke the behaviour.  But such “therapeutic” responses are hard to sustain in practice with a “difficult” person, who may often have the effect on others to suggest or make them feel “mad, bad, or sad”!

Some specific examples of various PD’s are discussed in the 2009 monthly Selfgrow newsletter, to which you can subscribe on this web site.  There are also various internet News groups that focus on specific Personality Disorders.

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