BPD and Interpersonal Change

Written By: Dr. Yedidya Levy

BPD is characterized by fears of both intimacy and abandonment, which can contribute to socially alienating and self-destructive behaviors. Fears of intimacy may be managed by pushing people away, while fears of abandonment may lead to overwhelming people who feel too distant. The experience of someone with BPD is often one of acute suffering, expressed as loneliness, shame, anger, anxiety, and more (American Psychiatric Association, 2022). Due to the interpersonal nature of BPD, an interpersonal intervention is often required to experience meaningful change. The psychotherapist engages with the client in a way that elicits the client's interpersonal behavioral patterns, revealing their relational consequences and offering or evoking curiosity about alternative ways of relational engagement.

Interpersonal issues often develop as ways of adapting to internal discomfort and are maintained through relational reinforcement. They may be behavioral patterns first utilized in early primary relationships as responses to caregiver behavior. However, interpersonal issues are almost always overdetermined, meaning they may reflect an adaptation to various interpersonal relationships, personality characteristics, biological predispositions, and life experiences. Borderline personality disorder, as described in the DSM-5-TR, is an example of a diagnostic label applied to a recurrent constellation of affective, behavioral, cognitive, and interpersonal patterns (American Psychiatric Association, 2022). BPD is theorized to involve biological predispositions toward emotional sensitivity interacting with environmental factors, including invalidating or unstable relational environments. To cope with these determinants of personality, the borderline pattern can be understood as an adaptation to avoid the acute emotional pain associated with abandonment or interpersonal overwhelm. The result may be a push-and-pull dynamic: rejecting those who come too close and urgently seeking reassurance from those who feel too far away. When this pattern is particularly acute, difficulties with intimacy and emotional overwhelm may also be expressed through self-harm and suicidality (American Psychiatric Association, 2022).

Some people manage to repair their relationships with spouses, parents, or friends by internalizing the feedback received in these relationships. Few, if any, successfully make substantial interpersonal change through reading a book or meditating on a mountain alone. In some cases, these activities can change intrapersonal habits and internal dialogue, but this does not necessarily translate into meaningful relational change with others. Changing personality features as they relate to interpersonal relationships requires practice. The person seeking change must experience the discomfort of a new pattern and consciously override the existing relational script. Good psychotherapy facilitates this repatterning through the experience of a new relationship in which old patterns can

emerge, be examined, and gradually modified.

References

American Psychiatric Association. (2022). Diagnostic and statistical manual of mental disorders (5th ed., text rev.; DSM-5-TR). American Psychiatric Association Publishing.