Mental Health Month “Personality Disorders”

The first day I was interning in a crisis center, I heard two women talking, and one said; “Whatever you do, don’t ever see a client who has Borderline Personality, they’re the WORST”

Shamefully I had studied but didn’t know very much about BPD yet, as I was only a year into my studies. I went home that night and read up on it and subsequently read some books devoted to BPD including the well-known book “I love you / I hate you.”

Shortly afterward I found out a friend of mine was BPD (BPD often goes hand-in-hand with Bipolar, as we often see Anxiety and Depression co-morbidly). She educated me significantly in a first-person account of what it was like to suffer from a personality disorder.

The very words ‘personality disorder’ strike me wrong. It’s not really giving someone a chance is it? If we label them as being disordered in some way?

It is thought personality disorders ‘grow’ in childhood and upon reaching maturity can be responsive to treatment or not, depending on the depth and extent they were reinforced in childhood. They usually have triggers such as the link between BPD and being sexually abused in childhood.

Why this is – isn’t so hard to understand if we consider, we all have personalities that are shaped by our experiences – any wonder then that certain experiences will commonly shape certain personalities and responses/reactions. If we take this to an extreme, a ‘disorder’ is a disorder of that personality caused by something wrong and traumatic that occurs to a child.

Why then doesn’t every child who is sexually abused BPD?

Because BPD and other personality disorders must be reinforced. If you are abused as a child but someone finds out, the person is taken away, you are told it was not your fault, the trauma is made better by a rectify and love and lack of shame, then you may well be affected by that abuse but not altered by it in terms of your personality.

If however, the opposite occurs and that trauma is reinforced, then by its very nature of reinforcement, the personality ‘disorder’ forms and every bad thing that happens afterward goes to continue that reinforcement.

It can work something like this;

Child A gets raped by her step-father. Child A tells her mom. Her mom calls her a dirty little liar and beats Child A. Child A is then raped repeatedly by her step-father who threatens to kill her if she ever talks again. Child A remains silent to her abuse for years and it goes on, unpunished. At 15 Child A goes to a party, gets drunk and is raped by a friend. Child A is told by her friends she is a slut and deserved it. Child A internalized all of this and develops BPD which among other things is characterized by a profound lack of trust in others.

Phrased like this, are any of us surprised?

In other words, a personality disorder is a consequence to abuse. As such I find the use of ‘disorder’ punitive because we’re saying the person has something wrong with their personality we are focusing on that, without really considering how this occurred.

Why? Because BPD can be very destructive, both to the person with BPD and those who know them. When you are dealing with someone who is capable of throwing everything into flux, it’s hard to make time to consider the background. You are too busy putting out the fires. And that is why BPD is so feared by therapists and wrongly, stigmatized as being a personality disorder people dread. Whether people dread it or not, any health care worker should aim to help those under their care and treat everyone equally. Perhaps that is easier said than done, but this is why more time should be spent learning about the formation of personality disorders.

Later on in my training I was warned again about BPD folk and told that they can be highly manipulative and destructive, they can and will always try to bring you down. I recall thinking ‘I can’t see how anyone could do that’ but later on I saw several colleagues have to defend their licenses against false accusations by BPD patients who were ‘testing’ them or flexing their muscle.

It appalled me to think anyone, even someone mentally ill, could deliberately go after someone with the sole purpose of trying to ruin their life. I found it hard to understand and empathize with them on that. Which is why I now understand why mental health workers can fear certain diagnosis in people. But despite this, I believe, given the right training and awareness, people can find ways to help those who even lash out at them.

BPD is characterized by a pull-push approach to relationships, an intensity, followed by a rejection, both of which are extreme, due to an inability to trust people shifting from intense attraction/like, to repulsion and hate. For most of us, this extreme is not impossible to imagine, perhaps if we have fallen out with a friend who back-stabbed us or a relationship went wrong because someone cheated on us, we went from love to anger at very least. With BPD those emotions are amplified and far more aggressive, with anger as the source. BPD individuals stoke the flame and are among the most angry and vitriolic of the mental spectrum.

For this reason when befriending someone with BPD it’s important to secure firm and unwavering boundaries. Ensuring the BPD knows the ‘ground-rules’ in other words, don’t flirt one day, and be cold the next, don’t be close one day and distant the next, because by doing that, you are feeding into their fears that nobody is trustworthy, and that will only bring on an extreme response.

Many BPD’s confess that the hardest part of the illness is the social disapprobation and isolation. They do not maintain long-term friendships or relationships, they are at high risk for suicide and self-harm, they vacillate between self-incrimination and feelings of persecution. In short, it’s an instability of their psyche due to being fractured in childhood.

This is among the myriad reasons I condemn child-abusers unreservedly. It is not just rape and abuse, it is messing a child’s life forever when you take someone and you fracture them. If we can take child abuse more seriously and catch more of them before they go on to ruin more people’s lives, this will have the knock-on effect of reducing the numbers of people who grow up to develop BPD and save them from difficult and unfair experiences in life. The one positive of a personality disorder is you can prevent it from happening, we cannot do that with all mental illness but when we can, we have no excuse but to try our hardest.

Mental Health Month”Grow up & forget about it!”

Do you know anyone who was sexually abused as a child? Were you? Was your daughter? Sister? Wife? Neighbor? Brother? Son?

Childhood sexual abuse and adult survivors of childhood sexual abuse (ASCSA) are in every society in every corner of our planet. It is often assumed children are resilient and can put up with a lot, and this is true, but childhood sexual abuse can destroy and does destroy so many parts of a child’s psyche we can honestly never know with any certainty how much was taken by the act of abuse.

What we do know is abuse, any kind of abuse, including sexual abuse, is going to have after effects that last long after the actual abuse ends. One of the ways this occurs is an unconscious attempt on the part of the child grown to adulthood (or near enough) in acting out the abuse in an attempt to understand it.

Does that seem crazy?

Very often organizations working with adult survivors noticed a pattern of repeat sexual and physical and mental abuse among populations who had endured these things. At first they believed a person who say, was raped was more likely to be raped a second time and this is borne out by statistics. But in addition to this increase likelihood of further victimization there was another pattern emerging; the unconscious re-enactment of aspects of the abuse by the survivor.

What that means in plain terms is, sometimes survivors will create situations similar to the abuse and actually reenact elements of the abuse, and go through those scenarios and possibly be re-victimized as a result. They will do this without being consciously aware of doing it.

Why would you ever want to do that?

It is thought this unconscious behavior is much like an unconscious wish to understand and reclaim what happened. Without intervention the individual is not aware they are doing it, and thus, when it happens is genuinely surprised (and re-traumatized) whereas when they are made aware this is a process of the mind trying to make sense of something that is hard if not impossible to make sense of, they can break the cycle.

Like many survivors who may turn to prostitution because of feelings of worthlessness and devalued degradation and shame, some will go in the opposite direction and have absolutely no sexual desire. These extremes are one form of ‘reacting’ to something the mind and spirit are trying to reconcile. Another way is the reenactment of the experience on some level. It has even been postulated that BDSM is one outlet for survivors to ‘act out’ their feelings and possibly reclaim their lost power.

Whether true or not, for others who have not had this experience, it may appear the individual is seeking to be abused on some level. It may even be an accusation thrown at the individual. Statements like; “You must want this / you keep putting yourself in these situations and letting it happen!” The individual will perceive this as being another condemning, blaming, shaming comment.

Abuse is hard to understand. I cannot understand why someone would sexually abuse a child, a woman, a man, an animal. I don’t think I could ever understand. So in absence of understanding, we sometimes go to great lengths to try to make sense of what happened to us.

I knew a woman who would drink a lot and go home with men and wait to see if they raped her. She was not aware she was doing this, until she really stopped the compulsion and thought about it. Then she realized she was seeing if she would be ‘betrayed’ again by a man who she had trusted and who had raped her when they had been drinking together. She had tried to talk to her friend who had raped her afterward about why he would have done this, he refused to say, and so she unconsciously put herself in similar situations to see if it would happen again and maybe understand it better. Of course when she realized what was happening she realized she did not want to be raped again! But until she came to that point she was unawares this was even happening.

Legally if she had been raped whilst drinking even if she consented to go home with someone, it would be rape if she did not give consent for sex and some would argue, if you are drunk you cannot give consent so with the exception of committed relationships where many times, partners will have sex when inebriated, the rule of thumb is, if you are not in a relationship and you or your partner are inebriated do not have sex with them because you cannot guarantee consent (unless it’s very obvious). Of course this is a difficult thing to gauge and it’s unrealistic to expect nobody to drink, so that’s where the legal system can get unstuck in issues of consent. However in most cases it is obvious for example if you are passed out drunk and someone has sex with you, that’s rape and you did not give consent, if you changed your mind and didn’t want to sleep with someone you withdraw your consent.

Therapy can be useful in working through trauma that involves enacting out parts of the abuse. Childhood survivors of sexual abuse go through triggering phases in their lives where it becomes challenging to deal with the history of their experiences. Typically these occur at puberty, during your first serious relationship, in pregnancy, during your child’s puberty and other occasions. It can be hard talking to family members about this, especially if the abuser was a family member. In a healthy marriage, talking about past sexual abuse histories helps you communicate what is and is not acceptable and what boundaries need to be respected, as well as bringing you closer.

Survivors of adult sexual abuse can have large issues with rage – anger – helplessness and anxiety.

Rage – anger at the perpetrator, at those who didn’t do enough to stop it, at oneself for being a victim, at people who trigger a reminder in any way.

Helplessness – feelings of impotence, uselessness, weakness, a feeling that nothing you do no matter how hard you try will change things or count.

Anxiety – fear, phobias, self-hate, secret-keeping, terror, flashbacks, nervousness, triggers, and general anxiety around anything related to or reminding of, the abuse.

Those as well as other symptoms can lead to severe mental health challenges, not least, depression and difficulty with trust and emotions. Unlike some who if raped may hopefully get some degree of immediate support, many times adult survivors of childhood sexual abuse, may never report what happened, may be disbelieved, may suppress it and keep quiet about it. Others may feel it was dismissed, forgotten about, considered unimportant and feel that people think they should ‘get over it’ by now. Those who are raped as adults and receive no support will probably also experience this isolation. That feeling can lead to mental illness if left to fester and remain unresolved. Rape Crisis Centers will see ANY child or adult of either gender who was raped or sexually abused in any way at any age at any time in their life. They have therapists who are trained in the legal ramifications, and also how to actually help those who have experienced this.

A fellow blogger reminded me to be mindful of male-rape and male sexual abuse and assault and how even if it does not happen with the same frequency it may suffer greater stigma because males are less likely to report any kind of sexual abuse, for similar reasons, but also because they are not as typical a victim and thus, they fear the condemnation of others who may think ‘you’re male, why were YOU raped? How could you have let that happen?’ As with women, and children, nobody LETS rape happen, they are victimized by a rapist and they survive that rape.

Men and boys of all ages can be raped by other men and boys. Men and boys can be raped by women, although this is the rarest form of rape and sexual abuse/assault it does and can happen. Typically the most common form of sexual abuse perpetrated by a woman toward a man is between a female relative (older) to a male relative (younger) when the power balance and physical strength is on the female’s side. The male relative may be told ‘that’s a fantasy come true’ when he tells his story of being raped by an older woman, but of course, for many young men this is no sexual fantasy, this is rape.

A man or boy can obtain an erection even against their will, because our bodies respond whether we emotionally wish them to or not, this is also true of women. A man or boy may be able to be touched to erection and then raped, and orgasm, and thus he may feel he was not raped even if he emotionally feels he was. A woman or girl can also experience this. The fear of ‘I came so I must have liked it’ is one big reason why males in particular do not talk about their sexual abuse. Another reason is, if a boy is raped by another boy, he feels people will think he is gay and whether he is or not, this can be a palpable fear in many social settings that perceive being gay negatively in some way.

For a boy who is not gay, being raped by a male, to the point of ejaculation is horrifying and leads them to have many internalized fears of ‘I must be gay / I must be twisted / I liked being raped’ instead of seeing that climaxing is no indicator of pleasure, it is a physical response to stimulation. Likewise, if raped by a member of the same-sex, the rape can be physically damaging, and emotionally scaring because that male may never have considered that they too could be raped. For girls and women we’ve always known it was a possibility, it doesn’t make it easier BY ANY MEANS but it’s a socially known phenomena, less for male-on-male-rape and yet, it has been used for years on the battlefield with both sexes.

Rape isn’t about sex it’s about domination, control, sadism, anger, violence.

Sometimes sexual pleasure is another reason that is gained by the rapist who inflicts pain, control, domination, fear, anger, violence. In other words, they get off on it. That’s the definition of a sadist and probably a sociopath (someone who has no empathy or regard for others). Equally narcissists can be deluded into thinking anything they do to anyone must be good because it feels good to them.

Those kinds of people capable of rape are our norm. But what about the good person who rapes? Is that possible?

Many times a best friend rapes their friend. In such incidences, everything you thought you knew flies out of the window. How could my best friend do this to me? What did I do to deserve this? You didn’t do anything. Sometimes people, even good people, do terrible things. We should not excuse a good person who does a terrible thing, because they committed an act that will stay with us forever. Oftentimes though, these are the very rapes that go unreported and can occur before adulthood.

Of course who wants to report rape when the system is broken? Ideally everyone should, that is the only way rapists are stopped. But even if you don’t, seeking therapy to work through the messed up feelings you will have afterward, as well as checking yourself physically and ensuring you are protected as much as possible from disease and injury is essential. This can and should include, an examination, evidence collected for should you proceed with a case (and you may not know if you want to at the time so get it taken so you have that choice) documentation of damage (for future reference in relation to your long-term health, blood tests for contracted sexual diseases and treatment if applicable including but not limited to, prophylactic treatment.

prophylactic treatment can include certain antibiotics that work to counter certain STD’s that are commonly transmitted. Others include The Morning After Pill which is not an abortion pill but a pill that prevents conception much like the regular pill but is taken once during the first 72 hours after a man has ejaculated inside you, to prevent unwanted pregnancy.

The least well-known prophylactic treatment is a HIV prophelactic. If you believe your rapist may have had HIV this is one measure to prevent contraction. You are given a large quantity of medication similar to the HIV treatment for up to six weeks typically a month, they have side-effects but they are reliable in preventing HIV transmission. Many people do not know about this and if it is applicable, it should be requested.

What about adults of childhood sexual assault? They are often raped in childhood, it is often a secret, as adults they may have scars and side-effects from this abuse including STD’s which further the shame and humiliation they feel. Seeing a good doctor who can go through your history and check on you regularly as well as prescribing appropriate medications can help though often the damage can be lasting and far-reaching which is why children abused in secret is so devastating as many are never treated until it’s too late.

With therapy it is never too late. I have seen people in their eighties who until that moment had never spoken about being abused as a child and at the termination of therapy they were glad they spoke out. It is never too late. Never.

But if you don’t get therapy for someone you love, it might lead to things you couldn’t imagine like them becoming the predator and abusing another child, as I saw many times happen, not because they were evil but because it’s a taught, learned maladaptive behavior that can be acted-out to the extent that the line between ‘abused’ and ‘abuser’ is blurred and finally, lost.

If you are friends with someone who has gone through something like this, be a friend to them and talk with them about it, don’t side-step around it, let them know you care and want to talk about it and encourage them to talk to a professional also.

Childhood sexual abuse survivors can be among the strongest most resilient souls you could ever meet, they are often the most inspirational and giving and helping. Nobody has to be destroyed by childhood sexual abuse, it is very rare that they are, but those who are, need the voice of us all, to prevent as much as we can, this quiet abuse that can be occurring right next door to us. We should all know the signs and symptoms of an abused child and not be afraid to check on a child we fear might be at risk of abuse.

That said, temper enthusiasm for helping with caution. Being brought up by a single father, many assumed I was at risk for being sexually abused by my father. He never did and never would, but I could see why they may have found it unusual for a small female child to be reared by their father. I was appreciative of their caution when I look back, but glad it didn’t cause further enquiry as that can be as damaging as doing nothing. It may be a fine balance but together, we can lower the number of children who are invisibly being abused in our society right now.