The experience of depression for the individual with borderline personality disorder can include significant anger, anxiety, and fear. The angry depression may be in reaction to rejection by a love-intimacy object… the partner. Leichsenring (2004) found that "depression in patients with borderline personality disorder showed significant correlations with interpersonal themes of torturing, strangling, parasitic relationships, or of an overpowering, enveloping force. These results are consistent with the results reported by Westen et al. (1992), who found an interpersonally focused 'borderline depression.' According to Dahl (1995), depression functions as the belief that one's wishes will not be satisfied. In patients with borderline personality disorder—but not in patients with higher levels of personality organization—this belief is associated with anger, which may be a reaction to the actual or expected nonsatisfaction of the borderline patients´ wishes." Belief that wishes are unfulfilled was associated with the perception that intimate others "torture, parasitically exploit, or overpower other objects." This perception may come from poor attachment, trauma, or abuse. It may also come as reactions to experiences of torturing, exploiting, or overpowering objects- that is, abusive parents or partners. "According to Dahl´s (1995) theory of emotions, both anger and fear represent the wish to distance from an object, possibly from a bad object, whereas anxiety represents the belief that one's wishes will probably not be satisfied. One interpretation of these results may be that patients with borderline personality disorder believe that they cannot distance from a bad object" (page 18).
The individual with borderline personality disorder gets stuck in an experiential quandary. He or she experiences him or herself as helpless in a dyad (originally, child to parent, and later partner to partner-Frieda to Cliff and client to therapist-Frieda to Selena), yet the dyad remains of ultimate importance. The individual is unable to acknowledge other than his or her own helplessness. Other individuals' relative lack of power is denied and they are declared omnipotent in the relationship. "Like the infant of early differentiation, the borderline patient attempts to re-fuse with the other to reconstruct the good dyad" (McGlashan, 1983, page 53). The individual may manipulate interactions to maintain a fantasy and need for omnipotence in being able to control the intimate partner. Control may be through internal fantasies and by actual manipulation of the other. These strategies include "impulsivity, selection of a dependent, object, seduction, overt and covert manipulation, and compliance" (page 53). "The experience of passive helpless may be reversed temporarily through sudden dramatic action that usually has no particular purpose. It is action for its own sake- the aim being a magical reclaiming of a feeling of omnipotence… Such action is object related in a primitive way insofar as it represents a repetition of old, infantile ways of controlling caretakers through soiling or tantrums. A variant of this is the borderline patient who precipitates repeated crises that force rescue from the environment… The feeling of helplessness may be reversed by relating to a dependent object, who can be manipulated at will" (McGlashan, 1983, page 53).
Both actions control the person who cares for the individual with borderline personality disorder. Unfortunately, that person may come to the conclusion that caring for the individual is not only too much work, but also ineffective. No matter how many times he or she responds to crises or demands, there is not sustained benefit, growth, or change. The individual with borderline personality has made this person feel what he or she feels… helpless. "Helplessness may be reversed via sexual seduction. This constitutes a prominent strategy among promiscuous borderline females and males (Don Juan characters), and although the means are genital, the aim is more primitive" (page 54). Security may be gained from stereotyping how the other thinks about sex, and can serve as a way to control attention. Playing the sexual slave may be secretively aggressive by asserting control over the partner who is sexually aroused. "Seduction can also involve aggression. That is, borderline patients may attempt a primitive sado-masochistic relatedness by overt or covert hostile taunting and teasing." The individual may fantasize rough treatment, degradation, and painful sexual treatment as "needed by the object rather than helplessly needy oneself." "For many borderline patients an offense is the best defense against helplessness. They pattern this offense after their perception of the other's strategy of (active or passive) aggression… When the omnipotent other is perceived as arrogantly grasping necessary supplies of help, the patient's identification may take the form of a retaliatory withholding. They remain stubbornly silent, communicating nothing except their intense resentment at being 'left' to remain in such a state. Such withholding may take the form of threats to terminate therapy or to suicide." While the previous statement was written pertaining to a client with a therapist, the individual with borderline personality disorder often threatens termination of the relationship or self-harm of some kind to an intimate partner. Frieda threatens Cliff with divorce, while she threatens Selena with terminating therapy. "Such threats constitute extreme attempts at coercing and extorting the 'withholding' environment into long-awaited rescue operations. The threat used is abandonment, which constitutes a reversal of their most central and terrifying fear" (McGlashan, 1983, page 55). "The strategy of compliance consists of trying to imitate, mirror or comply with the real or fantasied wish of the other. Differences with the omnipotent other must be disavowed through conformity. As such, compliance represents a more generalized form of seductiveness and is perhaps the most common of the borderline patient's strategies of control."
The individual with borderline personality disorder, such as Frieda has trouble experiencing or identifying with the experiences of the partner. Angry depression precludes or interferes with strong empathy with the intimate partner Cliff and what he may be going through in life and with Frieda's behavior. "Hartocollis assumes that the depression in patients with borderline personality disorder is more of a masochistic nature. This assumption is corroborated by the significant correlations presented here between depression and interpersonal themes of torturing and being overwhelmed, which were found only in the patients with borderline personality disorder" (Leichsenring, 2004, page 19). The individual utilizes a variety of emotional or psychological ego defenses in order to deal with intimacy. "Their defenses and reactions include self-doubt, reaction formation, undoing, reassuring the past, personalizing, denial, loneliness, displacement, projection, retreat, introjection, reaction formation, and defending the children" (Weddige, 1986, page 59). Weddige lists several thematic responses of the spouses or partners of individuals with borderline personality disorder. "One is the insidious symptoms of self-doubt wherein spouses in a repetitious, ruminative fashion blame themselves for the plight of their mates. They accuse themselves of contributing to the problems. Self-deprecatory and subsequent guilty and depressive themes then emerge. Often they attempt to undo and make up for being self-perceived inadequate spouses" (page 53).
This response is not surprising since the individual with borderline personality disorder is often so adamantly accusatory of the partner's wrongdoing. A conscientious partner- Cliff was nothing if not conscientious, would tend to take to heart the possibility that he or she has perhaps unwittingly hurt the individual. If unprepared or with self-esteem vulnerabilities, the partner may also begin to believe that the individual's accusations of unconscious negative intent and motivation as well. Furthermore, "One also frequently observes reaction-formation behavior when after particular tumultuous marital turmoil spouses become exceptionally devoted and excel with acts of kindness. Obviously this behavior is a defense against the prevailing angry affect." This response and interaction can be so positive that both partners conclude that they are "fixed" and that everyone and everything is now okay. Periods of exceptionally kindness, attentiveness, and intimacy allow members of the couple to collude in a self-deception of couple's functionality. They can convince themselves that the "bad times" are over and it is smooth relational sailing henceforth. The spouse or partner of the individual with borderline personality disorder is seduced into thinking there has been fundamental and permanent change or growth. The therapist may be cued about potential borderline issues, when one or both partners describe how great the relationship is "a lot of the time" or "most of the time" while also describing very painful events. Frieda could wax poetically about how wonderful Cliff could be and how fulfilling their relationship often was. Cliff wistfully spoke of all the great times they shared. There were periods during couple therapy, where both partners reported extended intimate interactions. Sooner or later however, there would be eruption of rage and disruption of relationship connectiveness.
"Closely allied to self-blame is the phenomenon of scrupulously reexaming the past to make sense out of current events. 'If only I had made this decision, our relationship would be different.' The bewildered spouses desperately attempts to understand their affectual state in terms of their past behavior. The implication is again their responsibility in the matter." Since the partner is told over and over that his or her decision or action was the root cause of hurt and disruption, he or she can come to believe that uncovering his or her "mistakes" would lead to better choices. Cliff, as the partner was as yet unaware that any action including historically positive or innocuous ones can become a horrific "mistake" entirely depending on the volatility or vulnerability of the partner Frieda in a given moment. What never bothered the individual before may now be profoundly triggering. The partner experiences the craziness of crossing a forbidden line without having moved in any new direction- perhaps, without moving whatsoever! "When incessantly confronted with accusatory, demeaning projections spouses may begin to believe what is said. The resultant reaction may range from depression and further self-doubt to angry defensiveness. Often the only validation for marital interaction resides in comments from the spouses or in self-instinct. The latter is often overwhelmed. The spouses gradually come to view themselves as somehow lacking in personal credibility." The therapist may first encounter the couple through meeting with the depressed partner coming for his or her personal issues- with encouragement from the as yet unidentified individual with borderline personality disorder.
Cliff had presented for individual therapy with questions about his chosen profession- human resources manager for a law firm. He contemplated if he should have and can still pursue his more artistic and creative interests. In his early forties, he seemed to be going through a classic mid-life crisis. Further questioning revealed a low level depression (below the threshold for Dysthymic disorder and well short of criteria for major depression) that had persisted since his mid-twenties. He had a ten-year marriage with Frieda, the woman he began dating in his mid-twenties. They had gotten married despite his reluctance from uncertainty that she was the right person. However, upon getting to the marrying age (late twenties) and the momentum of the relationship largely propelled by her desires, they had set a date for marriage. Up to the last minute, Cliff retained doubts that he was doing the right thing. Frieda had been somewhat volatile and he had born the brunt of various accusations and drama. But the wedding invitations had already been sent out and the respective parents were ready to have it happen. So, they got married. The drama had continued in the marriage and through two children being born. As the therapist followed the trail of vocational unhappiness to depression to relationship history, Cliff began describing Frieda's volatility and drama. The therapist sensed probable borderline behaviors and began asking leading questions that fleshed out the likely diagnosis. Although, wary of diagnosing someone that the therapist had not met, the therapist nevertheless could hypothesize Cliff's mid-life crisis as long-term marital dilemmas from dealing with Frieda's borderline tendencies. A job or career change was not going to resolve his depression from enduring relationship distress. In the early diagnostic stage, Selena as the therapist was not yet clear what might be Frieda's issues having not met her yet, but strongly felt that Cliff's issues were fundamentally entwined with his relationship with Frieda. Selena proposed shifting to couple therapy as the most appropriate unit of treatment for Cliff's personal issues, as well as for dealing with the relationship issues. Cliff posed this to Frieda who agreed to couple therapy.
Within the couple therapy, individual assessment continued for Cliff. For the longest time, Cliff managed to "pretend that there is nothing drastically awry within the house. If fully admitted to conscious awareness, the perpetual anger and chaos would be so painful that it must be denied. This process may prevail for years. Occasionally it is not until children, extended family, or an intuitive therapist clarify reality that such spouses can begin to focus with reference to their dilemma. Denial is often effective until the emergence of a sense of loss with reference to life or the intuitive perception that something is missing. Spouses may actually come to exist in a state of existential anguish or despair" (Weddige, 1986, page 53-54). The therapist may face this denial in individual or couple therapy with the partner of the individual with borderline personality disorder. Working through or with the denial may be a difficult and necessary part of therapy. Without acknowledging previous denial, the partner does not own his or her emotional and relational loss and process. Only then, can he or she confront the individual with borderline personality disorder behaviors. The therapist may recognize such a partner as Cliff who "present with a profound sense of loneliness. Their personal existence is characterized by their mates' impermeable ego-boundaries… Spouses' attempts to achieve a sense of intimacy are often thwarted. Without insight they remain bewildered, frustrated, and often angry when repeatedly unable to be acknowledged in what they though would be a nonthreatening give-and-take relationship. Occasionally this loneliness progresses to despair, despondency, or even enough introjected anger to result in a clinical depressive process. The depression may be the presenting symptom."
The therapist's own depressed attitude, sense of weariness, or clinical fatigue from working with an individual is a prompt to consider a borderline diagnosis. The therapist's counter-transference is similar to the experience of the partner to the individual with a borderline personality disorder. Selena had joined with Cliff in a sense as both victims of borderline stress. Rather than fulfilled or invigorated in the relationship, the therapist like the partner gets depleted from stress. "Often the beleaguered spouses who feel they exist in a chronic combat-zone of stress insidiously begin to displace and project their affect to their environment. This may result in mini-outbursts directed at friends or coworkers and create interpersonal difficulties. Often these spouses are not aware of the connection between their moodiness and their repressed affect. They occasionally begin to focus on their vocation, coworkers, or friends as if they had discovered the source of their dysphoria. This process compounds their dilemma. They may consciously feel they can exert some control over their external environmental whereas they cannot alter their marital situation." The therapist, especially a family or systems oriented therapist may be more sensitive to externalized problems with relational roots.
Cliff's internal or intrapsychic distress demanded some release or resolution. For years, it was directed elsewhere because direct confrontation with the individual was too intimidating. "By, what may be a defusing, restituitive defense mechanism, spouses may gradually begin to retreat from an intense, demanding, dependent, conflictual interaction. Almost paradoxically, decreased attempts at marital intimacy may actually result in increased marital harmony. Spouses may not consciously give up but rather instinctively learn how to give their borderline mates a nonintrusive, safer environment. The retreat may also be a conscious effort as spouses actually reinvest in other people, avocations, or a vocation. The identified patients lean that they can at least exert some semblance of control over other aspects of their lives whereas they perceive themselves to be stymied at home. This retreat sometimes leads to 'affairs' with attendant remorse or in other behavior such as excessive investment in a vocation or precipitous job changes" (page 54). Cliff had thrown himself into his career where he felt more fulfilled. Eventually, that proved to be insufficient. Not only had he had an affair recently, his earlier doubts resulted in a brief sexual encounter the week before the marriage and another one-night stand within a month after the marriage. He felt horrible for his venturing outside his marriage for sex in lieu of the emotional intimacy he could not get in the marriage.
"Spouses consistently attempt to maintain a psychic equilibrium via introspection, suppression, and repression. Living in a chronically chaotic state takes its toll. A borderline wife may neglect household chores. Attempts to assist in cleaning up are often met with angry tirades or rebuffs. The borderline views this as analogous to an intrusion into her ego-boundaries. The frequent affectual storms or rage episodes followed by hours or days of anger as the predominant affect also require the utilization of defense mechanisms by the spouse which obviously could easily result in symptoms of clinical depression" (page 54-55). Cliff told of his attempts to appease Frieda. He offered to be more involved with the childcare duties. Frieda was a stay-at-home mom. Frieda had insisted on this model from the outset, and Cliff had agreed. However, with Frieda's complaints about the children being so much work and Cliff's desire to be more involved with them, he offered to drop them off to school, take them to sports and activities on the weekends, and make time to be at teacher conferences and performances and games. Rather than welcoming his involvement, Frieda had accused Cliff of criticizing her performance as a mother. The individual with borderline personality disorder often interprets partner behaviors, including those intended to be supportive as insulting or dismissive. The partner often feels obligated to stuff any reaction or expressing feelings that could be further misinterpreted. The fundamental unfairness of being skewered for well-intended or benign actions is not only hurtful, but also frustrating and eventually, infuriating.
"Often spouses try to be extraordinarily nice in an attempt to cover their rage. This behavior may include compliments, gifts, and even being oversolicitous and patronizing. Often social and vocational plans cannot be made or changed because they somehow impinge upon the safety and security of borderline partners. The spouses often give in and work around this unreasonableness in order to avoid an explosion. Occasionally a pervasive jealousy, without merit or provocation, exists." Cliff felt that he constantly gave in to Frieda. The cost of ever "winning" was too high. He would get punished for it. Wanting anything seemed to threaten Frieda, so he would try to "buy" her agreement or take great pains to present any desire or opinion on his part as non-threatening as possible. His family and friends (her family and friends as well) thought he was incredibly deferential and sensitive to her. However, it often went for naught and Frieda exploded anyway. Frieda's outbursts scared and upset both Cliff and the children. Cliff felt he needed to shield the children from any tensions. "Others have nicely described the importance of defending the children in the family setting against prepsychotic assaults. The spouse finds it necessary to side with a child who is being unfairly criticized or berated by the borderline. Often a domestic struggle ensues that quickly gets out of control because of projection and splitting. The spouse vacillates between being an ally with one faction or the other. Obviously there is no comfort in either stance." Cliff felt he betrayed the children if he did not intervene when Frieda would go off on them, yet if he did or said anything (sometimes, if he did not do or say anything), Frieda would go off on him as well. He tiptoed around Frieda at times just because he knew how upset the children would be over another parental duel. At some point, one or both members find the relationship untenable, personal distress overwhelming, and/or the children and family becoming clearly harmed. The therapist thus may encounter the couple with the individual with borderline personality disorder through the individual or the partner presenting for therapy… or when either instigates couple therapy after years of dysfunction. Or, the therapist may discover this couple when working with a child and deciding to meet with the parents to gain information.