DBT Peer Connections

Building Hope, Community and Skillful Means

BPD Advocacy

Borderline Personality Disorder & Suicide Threats: Deconstructing the Manipulation Myth

I would like to deconstruct the myth that people who have borderline personality disorder (BPD) and attempt to commit suicide or otherwise harm themselves in response to fears of abandonment are somehow manipulative. I think this is a common misconception that further stigmatizes persons with BPD and likewise prevents loved ones who might otherwise be supportive from acting in ways that are empathic, assertive, firm but kind, and where setting clear boundaries based upon facts over feelings would serve a better purpose. Now you may think it counter intuitive to think that suicidal threats are not manipulative. However, I think it is extremely important that we understand the differences between feelings associated with suicidal behavior, intent, and the factors that reinforce suicidal behavior.

The 2 following paragraphs by Marsha Linehan, BPD’s foremost expert and originator of dialectical behavior therapy (DBT), an evidence based treatment for BPD, suicidal behavior, eating disorders, and other mental health problems aim to lend credibility to my argument,. The first paragraph is from Marsha Linehan’s treatment manual for BPD and addresses suicidal behavior as a form of manipulation, specifically. The 2nd paragraph is from a 32 article issue, Borderline Personality Disorder, that provides an overview of what BPD is and how DBT works to replace dysfunctional behavior with effective behavior through a delicate balance of accepting the person with BPD as he or she is, emotions and all, to activate change. Finally, I will restate the information according to my argument as simply and factually as possible. Please note that I added the bracketed words to speak to a broader audience not to change the meaning of the content. So, without further due, here’s Marsha.

Unfortunately, the instrumental character of suicide threats and parasuicide is frequently the most salient [prominent] one for therapists and theorists [and anyone] working with borderline individuals. Thus, suicide attempts and other intentional self injurious behaviors are often referred to as “manipulative.” The basis of this reference is usually a therapist’s [Loved one’s or other observer’s] own feeling of being manipulated” … “however, it is a logical error to assume that if a behavior has a particular effect, the actor has therefore engaged in the behavior in order to bring about the effect. The labeling of suicidal behavior as manipulative, in the absence of an assessment of the actual intent of the behavior, can have extremely deleterious effects. (Linehan, 1993 p. 61)

DBT assumes the problems of BPD individuals are twofold. First, they do not have many very important capabilities, including sufficient interpersonal skills, emotional and self regulation capacities (including the ability to self regulate biological systems) and the ability to tolerate distress. Second, personal and environmental factors block coping skills and interfere with self regulation abilities the individual does have, often reinforce maladaptive behavioral patterns, and punish improved adaptive behaviors” … “In DBT, treatment requires confrontation, commitment and patient responsibility, on the one hand, and on the other, focuses considerable therapeutic energy on accepting and validating the patient’s current condition while simultaneously teaching a broad range of behavioral skills. Confrontation is balanced by support. (Linehan, 1997)

In order to see these passages in the context of our discussion and to see that we are all on the same page, let us now consider the exact definition of the word manipulate which according to the dictionary is, ”to handle or use, esp with some skill, in a process or action.” (“Manipulate,” 1991, 1994, 1998, 2000, 2003) Now let us compare this definition to Marsha Linehan’s DBT treatment model which holds that people with BPD commonly do not have, “many very important capabilities, including sufficient interpersonal skills …” Now I ask you how can people with BPD skillfully manipulate a loved one through suicidal actions when the foremost expert on BPD tells us that people who have BPD lack the interpersonal skills required to be manipulative in the 1st place?

So now that you understand why and how suicidal behavior in response to feelings of abandonment is not equal to manipulation, you may still wonder, why then do I feel manipulated? The reason is that, “when people care about what happens to others, they do not want these others to suffer, but they cannot keep misfortune or suffering from happening; they are likely to blame the victims for their own misfortune and suffering.” (Linehan, 1993 p. 63) In other words, when we cannot stop loved ones from suffering, it causes us to suffer, and therefore, in order to stop our own suffering, which is within our power, we attend to blame our loved one, usually without awareness of the function the blame serves. The result is a “feeling” of being manipulated without necessarily being manipulated. The key to overcoming this misconception is being mindful to emotions and learning how to separate feelings from facts.

I hope that we now agree that people who have BPD and engage in suicidal behavior are not manipulative, but if you remain unconvinced, well, that is okay too. I do not write to tell you what to think; I write to give you things to think about. Therefore, whatever you may believe let me end my argument kindly that it may open your heart where your mind may resist. Compassion is a powerful medicine that everyone can afford. Compassion has no negative side effects. Compassion is caring even if you are angry, disapprove, or disagree with a person’s behavior. Compassion is gentle, firm, true, kind, open-minded, and strong. Compassion is a power that comes from within you.

References

Linehan, M. M. (1993). Cognitive-behavioral treatment of borderline personality disorder (p. 61, 63). New York: Guilford Press.

Linehan, M. M. (1997). Borderline personality disorder. The Journal of the California Alliance for the Mentally Ill8(1). Retrieved June 8, 2013, from http://www.portlanddbt.com/pages/linehan.html

Manipulate [Def. 1]. (1991, 1994, 1998, 2000, 2003). In Collins English dictionary (Complete and unabridged ed.). Retrieved June 8, 2013, from http://www.thefreedictionary.com/manipulate

Advertisements

Post a comment

Fill in your details below or click an icon to log in:

WordPress.com Logo

You are commenting using your WordPress.com account. Log Out / Change )

Twitter picture

You are commenting using your Twitter account. Log Out / Change )

Facebook photo

You are commenting using your Facebook account. Log Out / Change )

Google+ photo

You are commenting using your Google+ account. Log Out / Change )

Connecting to %s