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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This question often brings clients to the psychotherapist’s office. Not when you are a member of the majority of the population whose sexual identity (experiencing yourself as either girl or boy from childhood) and sexual orientation (whom you feel sexually attracted to, mainly from puberty onwards) fits comfortably with the ‘norm’ of your family and cultural group…

But when you or a family member does not “fit in” with the mainstream accepted sexual behaviours, it is met with resistance, and usually results in traumatic distress for individuals, families, friendship groups. Even one’s work occupation may be jeopardised by revealing that one is, for instance, homosexual: As late as the 1990s a male colleague was reportedly refused access to a university clinical psychology training program because he was gay. Recently, I’m told, a winner of a country’s pop singer competition found that a prize sponsorship was withdrawn when he revealed he was gay. Judgement is still so severe that the label of homosexuality can be used as a threat, for instance in sexual harassment: Imagine finding out at work that colleagues are wary of you because the boss suggested you might be a lesbian, when you preferred not to sleep with him… (This has happened!)

Until the 1970s there were university psychology departments who “specialised” in “curing” homosexuality through behavioral methods like electric shock treatment: Young men who sought help for the conflict and trauma they were experiencing were, for instance, shown a series of sexually provocative pictures of male and female models, with shocks following the presentation of the male pictures. Around the world the issues around exclusion, for instance in the USA navy program, were widely published and debated in every possible medium.

So many questions are asked: Can this be cured? Should it be “cured”? How can (e.g.) God forgive such a “sin” if I continue to give in to my desires for the “wrong” sex? Did I or my spouse do something “wrong” to “make” our child “choose” to be (e.g.) homosexual? When, and how, do I tell my parents / friends? How can I find a life partner if I do not enjoy the stereotyped social “gay scene”? What happens if we want children? How do I tell my wife and children that I want to have surgery to be a woman from now on? Someone in my rugby/tennis/hockey club saw my partner and I dancing: how do I prevent rumours and ostracization?

Genetic, Choice or Mental Disorder?

Well, it could be all or none of the above! I will try to explain briefly in lay terms, but encourage readers who wish to know more about the interplay of biology and environment, to read Chapter 7 “Genetic and environmental influences on mental development” in The Brain and the Inner World - An introduction to the neuroscience of subjective experience, by Mark Solms and Oliver Turnbull (2002, London & New York: Karnac).

The genetic factor:

When two “half” cells combine to form the first “egg” cell of a foetus, the gender gene from the sperm cell is either X or Y. The female ovum cell is always X. So we are born with either XX or XY chromosomes on one minute part of our genetic string of determinants.

The basic difference in predisposition to develop into either male or female has a “genetic” component of only one part of chromosome 23 (the last of pairs of genetic material coming half from father and half from mother as our “genetic” inheritance), i.e. one forty-sixths of our genetic inheritance predisposes our gender and sexual orientation. (In the 1990s there was excitement about the finding of a “gay gene” but the reliability of this research has been generally questioned.)

The general “default” rule is: all babies will be “female:” unless there is a Y chromosome. When the foetus has a Y chromosome (i.e. XY) “he” will be predisposed to develop into a person with male genitals, if all further necessary steps follow in the mother’s womb. Thereafter, if - and only if - all other parts of the developmental “recipe” occur at the right time and in the right order in the mother’s womb, “he” will develop a brain that is “male” in its structure and functioning.

If any part of the “recipe” is not followed exactly, there are different outcomes to the predisposed development: for instance, we may have a child with male genetalia, but a female brain factor, so that “he” feels “he” is and should be a girl. We could have a child who has XY chromosomes (such as found in testing of athletes) but who is in every respect fully and completely girl/woman.

The same chances of biological differentiation occur with “girl” babies with XX chromosomes.

Please note that the above conclusions are based on thorough and up to date research; the actual cell clusters, brain cell clusters and chemicals involved have been identified (Solms & Turnbull, 2002; Levay, 1994; Rogers, 1999).

Biological factors:

I use this term to refer to what people often incorrectly term “genetic”, i.e., actual physical influences rather than “psychological beliefs” - although, of course the two are inevitably intertwined!

I will use the influence on the XY-predisposed male development as an example; again, the same influences can change the observable outcome of the XX development. (Information is based on current lecture series by Professor Solms. Consult the sources listed for more detailed descriptions.)

Changes that can occur in the womb:

Remember, if specific sequences of development do not follow in the womb, XY babies would be female! As the foetus grows it develops sex cells known as gonads, which from identical early sex organs in XX and XY foetuses. At a specific point in later foetal development, the Y chromosome (when the foetus is XY determined) plays its role: A substance called testes-determining factor is released and changes the genetic make-up of the gonads that would have become ovaries, into gonads that will develop into testes. This is the beginning of the development of the foetus into a male child. But the process can be changed at many later stages!

When the “male” foetus is 4 to 6 months old (second trimester), testicles begin to develop and release the hormone testosterone, which is transported to all cells through the blood and is recognised by testosterone-sensitive sites on several other foetal organs, which change for later “male” development, e.g., male genitals will form, breasts will not develop fully, hair growth will be different, and the voice box muscles will be shorter and thicker, resulting in lower voice, etc.

While I’ve said in summary that testosterone causes the changes, in fact it has to be transformed into dihydrotestosterone (dht) by an enzyme called 5-alpha-reductase. According to Solms & Turnbull, “the female body will only become a male body if enough of this converted testosterone is present in it” (2002, page 226, my italics). So with intrauterine influences, as well as influences from outside (e.g. when a drug, progesten, was given to pregnant women in the 1950s and 1960s to prevent miscarriage, which inhibited the conversion of testosterone), a baby may develop who has testes and XY chromosomes, but have female genitalia and external development.

Still later in the 2nd trimester of the foetal development another critical process is necessary for continued male differentiation. The testosterone now has to be converted (by the enzyme aromatase) into oestrogen (estrogen) which is now responsible for “masculinising” the still-female brain. If this process is allowed to occur, the soon to be “male” brain becomes larger (similar to other male organs compared to female ones). The growth of the neurological material that joins the left and right halves of the brain (corpus callosum) is inhibited so that this communication pathway between the two brain halves is smaller in male brains (which is a factor in generally better specialisation functions, like visuospatial abilities, in the male, and in better linguistic and “multitasking” abilities in females).

Another important difference in male / female brain development is in the third of four specific groups of cells in the hypothalamus (”INAH-3″), which is significantly larger in male than in female brains. This results in different amounts of various hormones being release in the body and brain in various stages of life, in males and females. This also mediates sexual behaviour in “normally developed” males and female to be different, as well as other social behaviours, such as nurturing and socially aware behaviour of females (due to oxytocin) compared to aggressive and active behaviour of males (due to vasopressin).

So, if for instance, aromatase is suppressed or insufficient, we can have a female brain (causing female-typical behaviours) in a male body. Conversely, if the male brain has formed and, for instance, castration later occurs in childhood (e.g. accidentally during surgery or circumcision, or even intentionally, as in previous centuries to keep boys singing voices from deepening), by puberty the child will identify himself as male, with male sexual and general behaviours and urges, even despite early introduction of hormones to “make” him a female child.

Note that stress in the mother affects the types and quantities of hormones released in the foetus, and any of this interaction may interfere with the “recipe” to become a male or female child totally or partially (with brain and genital confusion). This means that a foetus may be more or less aggressive, fearful, “novelty-seeking” (Cummings, 1994), etc. if mother is stressed or not, e.g. by financial circumstances; war; absent, drunk or abusive partner/s; sickly older child / partner / parent / sibling etc.; exams; moving house; changes in work, etc! And such changes in the baby’s personality traits by time of birth may result in different treatment by the parents and others, of what the gender-apparent baby would otherwise have experienced, for instance, a baby overstimulated by panic-driven adrenaline in the mother’s womb, may be irritable and aggressive at birth, and receive reactions that foster male rather than female behaviours later. Which brings us to…

Changes that can occur outside the womb:

I suggested earlier that some forms of homosexuality could be due to “mental disorder” - a nice attention-grabber since it seems to support some popular belief that homosexuality and bisexuality are “dysfunctional”! I do not believe or imply that gender roles and gender identity is sometimes caused by “madness”. I also do not define changes from the norm in any way as “sin” or other form of “aberrant” behaviour.

The fact is that many factors may influence a growing child or even a grown-up adult to behave in ways that may not have been predicted by his/her gender template once out of the womb. Some of the behaviour changes occur very early because of early interactions from adults, until a child may be stereotyped into considering possibilities of behaviour that fall outside the “norm”. If such behaviours result in positive reinforcement (such as receiving positive attention lacking in the relationship with one or more parental figures), someone may choose a lifestyle in accordance with, for instance, being homosexual or bisexual, even if their natural sexual attraction is not towards that gender or the specific individual. This is not a strange phenomenon: it has occurred for many centuries in heterosexual marriages and liaisons, when individuals had no other socially safe options but to “marry” traditionally, and “multiply”! Certainly in many cultures of arranged marriages a spouse may similarly have to live a life of sexual intimacy with someone for whom s/he can feel no attraction, or even revulsion.

While girl and boy infants may elicit different interactions from other people because of their different brain development, in terms of for instance aggressiveness and activity level, the mere fact that they bodily present as male or female causes people to interact differently with them: adults tend to have more language interaction with babies dressed in pink and more physical interaction with babies wearing blue (irrespective of the hidden gender of the baby).

Several of my clients have spent time exploring the effect it had on them as children when, for instance, the father or mother wanted a boy and got a girl baby, or vice versa. Children eager to win approval and acceptance from parents will often behave more like the opposite sex child they believe the parent would have wanted, and thus that type of gender-behaviour could be reinforced till it becomes firmly incorporated into the child’s sense of his/her own identity. Conversely, children may unconsciously rebel against strictly enforced stereotypical gender role expectations from one or both parents, or family groups, by behaving contrarily so consistently that the habit may appear to have become fixed; they can then feel powerless to change what has been their assumed identity for so long, and defend their earlier “choice” through even stronger opposite gender behaviour.

Other common psychoanalytically-identified factors may also be part of the unconscious or even conscious decision to accommodate discomfort of gender-foreign behaviour in order to be psychologically safe, or free, or comforted, or loved (etc.). For instance, if one parent is powerful and abusive, it might not feel safe for the opposite gender child to behave like the gender model: that may be interpreted as accepting a life sentence of suffering; it may seem inevitable that the only way to survive is to “identify with the aggressor”. An absent parent can also have many influences on the acceptance or “choice” of gender identity: if most of the men in a community, for instance, are generally away (at war, or working away in a city, etc.) one of the results may be that women in the community have to fill “male” roles, and model such behaviours to female children who may extend it to sexual identity and choice. This could also happen in an individual family too, and an absence of a male role model may be a factor in homosexual behaviour in male children…

“Mental disorder” can imply that a person has made certain (usually unconscious) choices to behave in ways that could cause significant distress in personal, work, or social life. These “choices” are often defensive structures to prevent perceived threats of annihilation or rejection from being realised. There are too numerous scenaria to cover even in several books. Sometimes homosexual or bisexual behaviour is an unconscious defensive strategy due to postnatal life circumstances; oftentimes it’s a biological necessity, and “authentic” sexual identity. In any case, it’s deserving of the same welcome and respect that inappropriately judgmental critics claim for their own beliefs and lifestyle choices, including their many defensive structures!

Finding acceptance

So what do you do if you think you fall into one of the categories of gender role or gender identity that may cause rejection? Well, if you’re content with the role or identity, then you may just have to find ways of dealing with societal bias, like a genius, or any other category of person that doesn’t always quite “fit in” may have to do!

You may want to consult with counsellors at facilities that specialise in sexual role and identity adaptation, like The Triangle Project. If you wish you may ask a psychotherapist in private practice to accompany you on your journey of self discovery, and to help you find ways of dealing effectively with the reactions of the rest of the world, as well as your own inner conflict (if present). You may read books and articles on the subject or download informed opinions from specialised internet newsgroups with proper moderators capable of screening out unsubstantiated statements.

Our sexual identity and role/s are a part of our potential or actuality as a complete and wonderful human being with many fascinating physical, mental and emotional qualities… Your current discomfort could be the key that facilitates a journey of integration and healing of many aspects of your complex personality, irrespective or inclusive of the “sexual” choices you may make or sustain. Don’t be afraid to ask for help on the way: we all deserve it!