TIFT #110: Borderline vs. "Growth Tantrum"

Recently I have been involved in situations where someone who could clearly be called “borderline,” was rather suddenly “cured.” In both cases, I had been working with parents and felt the problem was better understood as a developmental issue rather than a deep seated personality problem. I’ll call these situations “growth tantrums.” I’m wondering what readers think.

History

The original use of borderline was to describe people on the border between psychosis and less severe pathology. In the old days that was attributed to a failure to integrate positive and negative experiences within the primary relationship, a developmental step that would hopefully take place during the third year of life, or age two. The result clinically was that the person had trouble relating to others as three dimensional and imperfect. Instead, to protect from the confusion and dissonance of experiencing the same caregiver playing opposite roles, the mind “split” or flip-flopped been perceptions of pure good or pure bad.

That formulation has validity, but the presence of volatile personality characteristics goes beyond those deep developmental arrests. The label became associated with the outward characteristics regardless of the presence of damaged “internal object relations.” It was applied more broadly and loosely to people with “stable instability” who exhibit the following characteristics:

• Fear of abandonment
• Unstable relationships
• Unclear or shifting self-image
• Impulsive, self-destructive behaviors
• Self-harm
• Extreme emotional swings
• Chronic feelings of emptiness
• Explosive anger

Judith Herman is credited with pointing out how often the original developmental failure and the later list of outward characteristics can be and often are the result of trauma and/or deprivation. She helped clear a large number of people from a negative prognosis and a prejudiced reputation they did not deserve.

Adolescent Development

Here is where it seems to me that the diagnosis can be confused with a more transient disturbance. Imagine a young person, whose difficult background and possibly other factors like genetics have left them with some “borderline” characteristics. Maybe there is ADHD to complicate things, and the family is dysfunctional. The young person doesn’t do well with relationships and performs somewhat erratically. As this young person enters adolescence, a gigantic new set of problems arises. The acquisitions of adolescence are challenging for most young people, but much more so for some. Here are the most important of them:

1. Learn impulse control and self-management.
2. Find out who you are, strengths, weaknesses, and how you interact with others.
3. Develop your personal values, not borrowed from family, but your own.
4. Learn to have deep relationships with authentic emotional intimacy.
5. Transition to what I define as adulthood: A sense of full ownership of one’s own life.

Successfully acquiring each of these attributes is difficult. It requires taking the emotional risks involved with new behaviors and experiences. For those who are more challenged, the result is a build-up of stress manifested by the individual’s usual repertoire of coping mechanisms, not all of which are healthy. From outside, their appearance is similar to and often diagnosed as borderline personality disorder.

A rite of passage

A useful model for making sense of this normal but confusing developmental challenge is the tribal rite of passage. In that ritual, the young person, with much preparation and adult support, goes on a solo quest into the night to prove to themselves and the tribe that they are ready for adulthood. When they return successfully, they are acknowledged as fully adult.

What happens, for those who are shaky in the above list of acquisitions, is that the task of letting go of parental support and taking on adult responsibility and behavior feels way too scary and daunting. The hight of the mountain to climb is made higher by an idealized picture of adulthood. Young people tend to set their standards and expectations based on media stars, seemingly perfect parents, or others who appear perfect from the outside. To make matters worse, the cultural expectation is to do this with joy and no particular difficulty. Few admit, even to themselves, that they have doubts about making it back from their personal nights in the wilderness.

On the outside the young person puts on a brave front. If there are breakthroughs of stress, they are blamed on those around or outside circumstances. To hold oneself responsible is not an option, first, because it is too shameful, and second, because admitting to difficulty leads naturally to getting help and from there to endless expectations of further success. It’s feels like committing to a perpetual struggle, a climb to the top of a mountain that keeps getting higher.

The “growth tantrum”

This is a very special collision of forces. The young person is facing a daunting challenge but can’t admit that they have doubts or are breaking a sweat. Furthermore, from their perspective, it looks like the adulthood they are supposed to desire is really an endless series of demands. The inner limbic protector tries to find relief, relief from having to keep taking emotional risks and relief from being expected to do this alone and without showing weakness.

The result is a drastic increase in stress and upset. The young person rages, does self-destructive things, is angry at everyone, develops unrealistic projects and plans, and squirms erratically to the point where parents and everyone begin to believe that something is drastically wrong. To outsiders, too, this looks like it will go on forever. It must be a fundamental personality disorder.

Caring families call in the mental health specialists, who diagnose borderline personality and recommend intensive care focused on the symptoms, that is, treating the ineffective coping and the characteristics listed at the beginning of this post. Too often, they aren’t aware of the monumental struggle going on underneath.

A more positive perspective

If we see the symptoms as indications of a self-limited internal struggle, we will pay more attention to signs of the positive side of the ambivalence. We will realize that few young people will admit that there is a positive side, so we’ll ignore the negatively biased words. Instead we’ll watch for positive behavioral indicators and engage with them. We will keep patience and focus on helping the young person traverse an exceedingly difficult passage. We will remind ourselves that we are “paddling downstream,” meaning that our support is aligned with the power of a natural, inborn tendency to grow and ultimately trade childhood for the freedom and joys of adulthood.

Seeing the positive

Assuming a natural ambivalence, it is important to look at the young person’s behavior. Are there indications of a positive drive to grow? As described above, it is hard for young people to admit that they are trying because doing so can be interpreted as a commitment to lifelong struggle. For that reason, they are more likely, especially in what they say, to emphasize the negatives. It even affects their adoption of unappealing manners and dress, not to mention seeing outside factors as “preventing” them from making progress in life. “My school counselor won’t let me take the courses I need to be motivated.” The best excuses have some truth, but are given more weight than they deserve. In spite of these impediments, is the person still taking emotional risks? Are they moving towards adulthood anyway?

The balance between motivation to move forward versus motivation to avoid fear and discomfort by staying stuck is the key factor in knowing how to proceed. When there is forward movement, then the job is to support and nurture it.

It’s often hard for parents to see the how hard the young person is working towards maturation and progress. They often focus on what is said or the things that remain unhealthy. And more than once, I have seen parents decide it is time for “tough love,” at exactly the point where the young person is ready to move forward.

Working with the positive

Recognition of the young person’s efforts and positive motivation, even when they are denied, is one of the most powerful ways to support those efforts. Because of the tendency to experience positive expectations as demands, the first thing to know about positive support is to keep it low-key. “Don’t make too big deal of the positive things.” The young person’s inner limbic mind doesn’t understand the dimension of time or the true nature of adult life, so praise is easily misinterpreted as a demand to keep making scary moves forever. I also like the phrase, “No Visa or Master Card.” By that I mean parents need to avoid responding as if a bit of good behavior can be interpreted as a future trend beyond the here-and-now success. Doing so makes it more scary and sets the young person up for future failure. The young person can only combat these demands by producing failure to show that giving credit for future success is not a good idea. Simple recognition of a positive action is a powerful support because it becomes “real” in the ambivalent mind.

Recognizing that slips are not failures

In the intense struggle between conscious desire for success and internal ambivalence, the course is up and down. Setbacks are normal. Parents and therapists need to be patient and see adverse events as temporary until proven otherwise. Optimism works as a form of support for the positive and counteracts the tendency to give up.

Leverage

When indications of progress are not to be seen, then the principle is the same as for people suffering from addiction. Leverage means finding something the young person values highly and under the control of family,  job, or even friends, to be set up as contingent on the young person’s behavior.

The “if” part of the contingency must be something easily determined and clear. It is OK for this to be something with which the young person does not agree, as long as it is based on genuine judgment by the adults. The “if” should be something related to the level of functioning, something like grades, performance in the outside world, or self-control. Those show that the parents want to help with growth, as opposed to wanting control for its own sake. The worst are requirements that represent younger or more childlike behaviors like keeping a spotless room,  doing chores, or being too close with parents.

The “then” part of the contingency is important, too. What kids value most is often the cellphone. When the young person is lacking in healthy socialization, that could be the wrong thing to take away, but it is often the most potent for teens. Creative positive “punishments” like exercising or doing homework “faster than ever” may not have been thought of. At older ages, it might be housing or other financial support. When drugs are blocking progress urine or other testing can be a requirement for some other privilege. The downside to these measures is that the young person might just give up. Parents are often afraid of suicide, which the therapist must assess. Another consideration is the young person who is “street smart” enough to go out on their own without the maturity to do so safely. That can be a genuine danger. These negative consequences may limit the usefulness of leverage.

Of course the young person will not like these contingencies. They make staying stuck even less comfortable, thereby increasing stress. The young person will object and may say the parents are trying to prevent their growth or exercise control for the sake of control. Hopefully these arguments are clearly not true and don’t “stick.”

Beyond leverage

In interventions for addiction, perhaps the ultimate contingency is withdrawal of engagement, that is, loss of the sense of connection. Humans need connection, especially with family. Of course addicted people and young people who are stuck will deny it, but the truth is that disengagement on the part of family, if done in a non-punitive way can be the most powerful reason for facing scary, growth-oriented behaviors. In the addiction field this disengagement is called, “detach with love.” Disengagement can be spoken or not, announced or not. It might take the form of an overt statement like, “I’m sorry I can’t support you in this decision. I am only able to support decisions I think will lead to what I believe will be a healthy outcome.” It needs to be done in a way that is not controlling but aimed at encouraging growth as opposed to stagnation.

Controlling behavior

Controlling for the sake of controlling, is a signal of lack of support for progress. When it comes from parents’ difficulty transitioning from responsible adult to co-adult, they are more likely to be able to recognize the pattern and change it. When it comes from a deeper unconscious need to sabotage the child, then it is harder to manage. Young people may or may not be capable of moving forward in spite of this lack of support, depending on age, maturity, inner strength, and outside supports.

Enabling

Enabling comes in several forms. When it persists, I see it as too powerful to expect a young person to resist its effects. The most obvious form is tolerating low functioning or rewarding immature behavior. A second form is when parents split themselves into the classic configuration of a “softie” parent and a “tough” one. Until they begin to work out their differences and function as a unit, the young person is left to raise themselves with no effective parenting or support. The third form of enabling is harshness or expecting too much. Harshness on the part of one or other parent becomes a valid reason for blaming them and for the negative side of the ambivalence to take on strength.

Containment

The young person’s response to a setback or failure is often a impulse to give up. This can also be expressed in rage and threats of self-destruction. What the young person needs from adults is the same as a two-year-old having a temper tantrum, to be held closely and prevented from doing permanent harm. For parents, as for therapists, this is “containment.” It means being the larger person, not taking the insults personally and patiently expressing the expectation of the bad behavior burning itself out. If it doesn’t burn out, then it will be necessary to set concrete limits or to seek a larger container such as hospitalization, police, community authorities, etc. If containment is not achieved, the tantrum will escalate until it is. And that can be very dangerous. In fact, it can be thought of as testing to see if safety barriers will hold. Thus, containment is really the psychological sense that one’s own rage is not too big or too dangerous for the adults to handle. When we are not in a position to contain that kind of rage, it is actually positive to admit our weakness and limits. Admitting weakness is an indication of strength.

Borderline or not?

Regardless of personality makeup, all humans are susceptible to growth tantrums. Any time there is fear and ambivalence around moving to a next level of maturity, it can be manifested in this way. It involves an inner protector caught between opposing drives and fears, when societal expectations don’t permit open expressions of difficulty.

When the end result is success and the last battle has been won, if the tendency towards volatility subsides, it is fair to say it was a growth tantrum, not a personality disorder. There might also be some of both, some symptoms of emotional volatility made more dramatic while experiencing a growth tantrum. The good news is that when the person has successfully traversed one growth tantrum, the next one will be easier. Success puts the individual on a positive trajectory towards growth and, even with additional episodes, progressive improvement in mental health. 

Jeffery Smith MD

Photo Credit:  Aziz Acharki, unsplash