I live at the bottom end of the world and a constant frustration as a youthworker within my particular denomination is a reliance on anecdotal youth ministry research versus applying the sciences that already exist and overlap a number of aspects of life for young people and those in the throes of adolescence.
In this particular case, my interest lately has been spurred towards trying to create a lay person’s understanding of the symptoms, behaviours and basic methodology for dealing a young person who may have Borderline Personality Disorder (BPD). In no way are these thoughts definitive – in fact, the opposite, they are challenging and just beginning to percolate in my mind. Whilst I’ve tried to source my information from reliable sources – my own ideas and theories are just that, and should in no way be considered anything other than ruminations on an shadow part of our youth culture, or challenges for youthworkers.
In a culture where mental health issues are increasing and the adolescent timeframe for chaos is expanding, my immediate concern is that traditional youth ministry and young adult frameworks do not allow enough space or information to deal constructively with these issues, that have broad community impact.
Advice from a former mental health nurse now working as a youth pastor, and a social worker specialising in mental health pushed me towards the BPD information. The motivation was looking for coping strategies both from a external pastoral management aspect, as well as coping strategies for those who were more closely intwined in relationship with the young person.
Further conversations alerted in my mind a peculiar phenomenon – both mental health workers reported a high incidence of this disorder, which is already primarily prevalent in young women aged 18 – 30, amongst Christians.
First – a completely incomplete summary of some key behaviours and trends.. it must be borne in mind that at best Borderline Personality Disorder remains a controversial and multi-faceted diagnosis with conflicting idealogies around best practice in treatment and diagnosis. There are many points where the research currently and widely available concurs, and many websites helpfully draw together the conflicting views for those that wish to explore the boundaries. I’m simply looking for common thread that can help in finding a simpler pathway forward.
Borderline personality disorder (BPD) is a serious mental illness characterized by pervasive instability in moods, interpersonal relationships, self-image, and behavior. This instability often disrupts family and work life, long-term planning, and the individual’s sense of self-identity. Originally thought to be at the “borderline” of psychosis, people with BPD suffer from a disorder of emotion regulation. While less well known than schizophrenia or bipolar disorder (manic-depressive illness), BPD is more common, affecting 2 percent of adults, mostly young women. There is a high rate of self-injury without suicide intent, as well as a significant rate of suicide attempts and completed suicide in severe cases. Patients often need extensive mental health services, and account for 20 percent of psychiatric hospitalizations. Yet, with help, many improve over time and are eventually able to lead productive lives.
While a person with depression or bipolar disorder typically endures the same mood for weeks, a person with BPD may experience intense bouts of anger, depression, and anxiety that may last only hours, or at most a day.
[NB: Whilst this is an important differentiation between depression and BPD, it is also helpful I think, in examining the moments of ‘depression’ in adolescent behaviour associated with more typical identity/independence/stress behaviours – this is different too, to an adolescent that may display different identity trends within the space of a day or week, depending on the socail context they are within.]
– vulnerability vs invalidation
– active passivity (tendency to be passive when confronted with a problem and actively seek a rescuer) vs apparent competence (appearing to be capable when in reality internally things are falling apart)
– unremitting crises vs inhibited grief.
Some of the more typical behaviours and general observational trends are noted below, including the priorities of values and distastes.
Here is a hypothetical profile, in terms of the five-factor model of personality, for Borderline Personality Disorder.
Chronic negative affects, including anxiety, fearfulness, tension, irritability, anger, dejection, hopelessness, guilt, shame; difficulty in inhibiting impulses: for example, to eat, drink, or spend money; irrational beliefs: for example, unrealistic expectations, perfectionistic demands on self, unwarranted pessimism; unfounded somatic concerns; helplessness and dependence on others for emotional support and decision making.
Excessive talking, leading to inappropriate self-disclosure and social friction; inability to spend time alone; attention seeking and overly dramatic expression of emotions; reckless excitement seeking; inappropriate attempts to dominate and control others.
Difficulty adapting to social or personal change; low tolerance or understanding of different points of view or lifestyles; emotional blandness and inability to understand and verbalize own feelings; alexythymia; constricted range of interests; insensitivity to art and beauty; excessive conformity to authority.
Gullibility: indiscriminate trust of others; excessive candor and generosity, to detriment of self-interest; inability to stand up to others and fight back; easily taken advantage of.
Underachievement: not fulfilling intellectual or artistic potential; poor academic performance relative to ability; disregard of rules and responsibilities can lead to trouble with the law; unable to discipline self (e.g., stick to diet, exercise plan) even when required for medical reasons; personal and occupational aimlessness.
Want to be free to pursue their desires while still getting dependency needs satisfied.
Behaviors which destabilize personal relationships, idealizing and devaluation of potential care givers and lovers, angry disruptions of close relationships, frantic efforts to avoid abandonment.
Intense unstable relationships in which the borderline is perceived to always end up getting hurt.
Repetitive self-destructive behavior, often designed to prompt rescue.
Chronic fear of abandonment and panic when forced to be alone.
Distorted thoughts/perceptions, particularly in terms of relationships and interactions with others.
Hypersensitivity, meaning an unusual sensitivity to nonverbal communication.
appearance of competence
mood altering substances
losing emotional control
a dangerous and malevolent world
being powerless and vulnerable
being inherently unacceptable
Less than twenty minutes into my initial research – the succinct descriptions were raising alarm bells for me. In my own brief and unqualified psychology career (ie: i’m a youthworker), immediately I can think of 7 young women who all displayed prominent symptoms of this disorder over the tenure of my youth ministry involvement. Anecdotal yes, but still disturbing.
But where is the science, the research to back this up?
Why this high incidence among christian females, let alone increasing numbers across the board of this behaviour that wrecks havoc across lives and communities.
The fallout of this disorder within communities and especially Christian communities that are upheld on foundational principles of unity, common understanding, truth and integrity, as well as common values that are primarily misaligned with some of the “habitual passions” described below is substantial.
The confusion, doubt and introspective questioning that enters even the surest of relationships can see the impact of one BPD case impact dozens within a community. The drive to meet the perceived needs can spiral the construction of a community into unusual and emotionally manipulated, dominated depths.
Unbelievably dangerous and destructive, the BPD sufferer is a victim themselves, and yet remains the perpetuator of so much of their own villainy. I’m juxtaposed to sympathetic position for the young, but increasingly those behaviours that when confronted and assisted show no signs of improvement or willingness to address the condition are potentially dangerous to themselves and others, that I am becoming less and less tolerant.
What does all this mean for youthworkers in particular?
The similarities between mild BPD symptoms and your average adolescent teenage girl are multiple. And it’s not just a condition of the femininine. However, the subtleties – the behaviour of ‘splitting’ whereby all things are simply all good or all bad, leading to idealisation and devaluation, is so closely linked in my mind to the journey and development of abstract & critical thinking so crucial to adolescent development, that I wonder about the relationship between them, and the factors or variables that could influence..
ie: destructive and repetitive devaluation of the BPD at home or within family constructs, that leads to idealisation of a “Rescuer” who primarily arrives in the form of a romantic interest (habitual passions kick in). Within modern western Christianity – this ideal would be supported by the idea of a “Mr Right”, who being perfectly matched by God to the BPD would satisfy all perceived needs and dependencies. The “all good” model. The BPD then goes in search of this, even from an early age. The more she fails to ‘find’ such fulfilment, the more indicting the condition and search becomes. The more corporate the “failings” of the common group of men (thinking here about the twenty-something phenom referred to once here and screams to me of some of these undertones)..
Mostly, I think it’s interesting for us in the Christian world because of the moral stance we take on sexuality pre-marriage. Where romance, sexuality and physical expression would be a very common form of expression for a typical BPD, within the Christian realm, do those behaviours become even more magnified with the additional of a demanding moral code in conflict with core values of a BPD? What further emotional spiral does this cause?
For youthworkers this article on Past, Present, Future from Youth Specialties in 2004, offers a brief overview of the changing face of mental health, young people and youthworkers and ..
So many questions.. and I’m pretty sure this is enough for somebody to write a thesis on. However, it shouldn’t be me, but I’m fascinated by the ideas.
What I’d love would be to see some more research, some more youthworker friendly and objective resource being supplied into youth work training and ministry environments that I’m sure are possibly causing more harm than good with traditional Christian counselling.