What is Borderline Personality Disorder with… Petulant Features?
Thursday, January 4, 2024. 6:46 AM. This is for my son, Dan, who might have more to say…
What does it mean to be petulant?
adjective disapproving US /ˈpetʃ.ə.lənt/ UK /ˈpetʃ.ə.lənt/
easily annoyed and complaining rudely like a child Synonyms cranky (bad-tempered) mainly US informal fractious irritable peevish testy tetchy
Borderline Personality Disorder (BPD) is a complex and challenging mental health condition characterized by pervasive patterns of instability in interpersonal relationships, self-image, and emotions.
It’s typically co-mingled with narcissistic traits as well. There are few if any “pure” borderlines or narcissists. Most personality disorders are a turgid blend of the unseemly.
Within the spectrum of BPD, the petulant subtype represents a distinct manifestation with its unique set of symptoms and challenges. Namely, they are particularly difficult and abusive to deal with.
I’m pretty sure my first wife could be diagnosed with Borderline Personality Disorder with the petulant sub-type.
Because I look back on my first marriage with less than fondness (I was 19 when my son Dan was born), I’ll be exploring the clinical features, diagnostic criteria, potential causes, and treatment options for the petulant borderline.
Borderline Personality Disorder: a brief, and hopefully adequate overview…
Definition and Diagnostic Criteria
Borderline Personality Disorder is a serious mental health condition that affects approximately 1.6% of the population, according to the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5).
To receive a diagnosis, you must exhibit a pervasive pattern of instability across multiple domains, including self-image, interpersonal relationships, and emotions. The DSM-5 outlines nine criteria, and you must meet at least 5 to be diagnosed with BPD.
However, many therapists balk at the 1.6% figure. BPD is based on a consistent pattern of behavior. I’ve heard psychiatrists report with confidence that 5-10% of humans exhibit some measurable degree of BPD traits.
I think it’s best to say this is a difficult disorder to diagnose, and your mileage may vary.
Core Features of BPD
Intense and Unstable Relationships: Individuals with BPD often struggle with forming and maintaining stable relationships. They may idealize others initially, only to devalue them when faced with perceived abandonment or rejection.
Distorted Self-Image: A lack of a stable sense of self is a hallmark of BPD. These humans may experience rapid shifts in self-perception, leading to identity confusion and an unstable sense of who they are.
Emotional Dysregulation: Emotional instability is a key feature of BPD, manifesting as intense mood swings, impulsivity, and difficulty managing strong emotions, such as anger, anxiety, and sadness.
Fear of Abandonment: Humans with BPD may go to great lengths to avoid real or perceived abandonment, which can lead to tumultuous relationships and impulsive behaviors.
Self-Harm and Suicidal Behavior: BPD is associated with a heightened risk of self-harm and suicidal ideation. These behaviors often result from emotional turmoil and the desire to cope with intense emotional pain. However, this is not a universal feature.
My ex-wife never threatened suicide, but she delighted in unnerving others by praising it alongside homicide, as an efficient way of resolving interpersonal conflict.
What is the Petulant Subtype of Borderline Personality Disorder?
The petulant subtype of BPD is characterized by specific behavioral patterns that differentiate it from other subtypes, and I promise to address those other subtypes in future posts.
Individuals with the petulant features may display a pervasive pattern of negativistic attitudes, defiance, and resentfulness. Their behavior is often driven by a fear of vulnerability and a profound need for control.
Diagnostic Criteria for Petulant BPD
In addition to meeting the general criteria for BPD, individuals with the petulant subtype typically exhibit the following characteristics:
Negativistic Attitudes: These humans may frequently express negativity, opposition, and resistance, often reacting with defiance to perceived expectations or requests.
Resentfulness: A chronic sense of resentment towards others may be present, fueling interpersonal conflicts and making it challenging to establish and maintain healthy relationships. This is the slippery side door where the narcissistic features slip in.
Fear of Vulnerability: The petulant subtype often involves an intense fear of being vulnerable or dependent on others, leading individuals to adopt defensive and confrontational behaviors. My ex never discussed needing or wanting anyone.
Difficulty Accepting Help: Humans with petulant features may resist accepting help or support from others, viewing it as a sign of weakness. My ex was defiantly proud, and could never apologize, or ask for help in any way.
Impact on Interpersonal Relationships
Understanding the petulant subtype is crucial for comprehending the unique challenges it presents in interpersonal relationships. These people grind and wear away at your soul if you let them.
The negativistic attitudes and resentfulness can create a hostile environment, making it difficult for humans suffering from a petulant BPD to form and sustain meaningful connections. In other words, it’s pretty fu*king abusive.
The fear of vulnerability may result in emotional distancing, further isolating them from potential sources of support. But not all sources:
Everybody knows that you love me, baby
Everybody knows that you really do
Everybody knows that you've been faithful
Oh, give or take a night or two
Everybody knows you've been discreet
But there were so many people you just had to meet
Without your clothes
Everybody knows. Leonard Cohen
Why do some humans develop Borderline Personality Disorder?
Biological Factors:
Genetics: Research suggests a genetic predisposition to BPD, with a higher risk among those humans with a family history of the disorder. Specific genetic factors influencing temperament and emotional regulation may contribute to the development of BPD.
Neurobiological Factors: Alterations in brain structure and function, particularly in regions associated with emotion regulation and impulsivity, have been observed in individuals with BPD. Dysregulation of neurotransmitters, such as serotonin and dopamine, may also play a role.
Environmental and Family Of Origin Factors
Childhood Trauma: A history of childhood trauma, including physical, emotional, or sexual abuse, is a significant risk factor for BPD. Traumatic experiences during critical developmental periods may disrupt the formation of secure attachments and contribute to maladaptive coping mechanisms.
This was the case with my ex. She lost the two most important attachment figures in her life, her father, and a beloved uncle in two separate car accidents, only weeks apart, at the tender age of 10.
A new violent and abusive stepfather soon after entered her life, bringing chaos, and alleged sexual harassment.
I’ve read research that suggested that 65% of borderline women were sexually abused as children. My clinical experience says that feels about right to me.
Invalidating Environments: Growing up in an environment that invalidates or dismisses emotional experiences may contribute to the development of BPD. Invalidating environments can exacerbate emotional dysregulation and hinder the development of healthy interpersonal skills.
My ex learned quickly to assert dominance. After her father’s death, she was 1 of 6 siblings.
It’s also true that her marriage to me was also an invalidating environment for her.
I always thought that hiding and lying about my true feelings was the best way to “handle” her. I now know she needed a stronger partner who could set healthy boundaries. I was decades away from acquiring those skills.
My surrender offered her the illusion of control. And I was so relieved, I could not see the damage I was doing.
Her behavior was so off-putting that I completely pulled away emotionally, and I did that early, and thoughtlessly. I left my borderline wife to her own devices and withdrew from her. We only divorced when she moved on to the man who would briefly be her next husband. I am shocked to remember that marriage consumed 23 years of my life.
Psychosocial Factors
Attachment Theory: The quality of early attachments is a central aspect of BPD development. Insecure or disorganized attachment styles may contribute to difficulties in forming and maintaining relationships, leading to interpersonal challenges later in life. This is so essential.
If I knew at 19 what I know now about attachment, I would have recognized that neither of us was psychically eligible to marry, let alone raise a child. I cringe in the face of my early adult life.
Cognitive Factors: Cognitive distortions, such as black-and-white thinking, idealization and devaluation, and a heightened sensitivity to perceived abandonment, are common in humans burdened with BPD. These cognitive patterns influence emotions and behavior, contributing to this disorder’s symptomatology.
And it is these cognitive distortions that I most vividly remember.
Living with my ex-wife was a masterclass in sadistic devaluing. But she came by this orientation honestly, her family of origin taught her nervous system that whenever she was not in utter control, she was in imminent danger.
Treatment Approaches for Borderline Personality Disorder with Petulant Features
Psychotherapy
Dialectical Behavior Therapy (DBT): Developed by Dr. Marsha Linehan, DBT is a widely used and effective therapeutic approach for individuals with BPD.
It combines cognitive-behavioral techniques with mindfulness and validation strategies to help humans regulate emotions, improve interpersonal skills, and reduce impulsive behaviors.
Ever since my first mistake in attempting to conduct couples therapy with a narcissistic man and a borderline woman, I’ve relied on the willingness to do DBT as a deciding factor as a requirement for any couples therapy.
Mentalization-Based Therapy (MBT): MBT focuses on enhancing individuals' ability to understand their thoughts and feelings and accurately interpret the intentions of others. This approach aims to improve emotional regulation and interpersonal functioning. This is similar the the word being done with grandiose narcissists in Germany.
Schema-Focused Therapy: This therapeutic approach addresses maladaptive schemas or core beliefs that contribute to BPD symptoms. By identifying and challenging these schemas, individuals can develop more adaptive coping strategies.
Medication
Antidepressants: Selective serotonin reuptake inhibitors (SSRIs) and other antidepressant medications may be prescribed to help manage mood symptoms associated with BPD. However, there are no specific drug treatments for BPD.
Mood Stabilizers: Medications such as mood stabilizers or antipsychotics may also be used to address impulsivity, aggression, and mood swings. This, on the other hand, has been a very important distinction.
I believe that one of the ways our mental health regime fails is with dull-normal clinicians making a confidently wrong diagnosis.
I can’t tell you how many “borderlines” (described as such by their husbands who read too much and watch too many youtube videos), are suffering from a very treatable mood disorder.
At this point in my practice, I have a deep bench of psychiatrists and neuroscientists who I regularly consult with as needed for my clients. I color in the lines.. and I stay in my sandbox.
Other Supportive Therapies…
Group Therapy: Group therapy provides individuals with BPD an opportunity to practice interpersonal skills, receive feedback, and gain support from others facing similar challenges.
Family Therapy: Involving family members in the therapeutic process can help improve communication, address relational dynamics, and create a more supportive environment… when it works. But bad family therapy will just be a short-attention-span theater for long-suffering other family members.
Mindfulness and Self-Reflection
Mindfulness Practices: Mindfulness techniques, such as meditation and deep-breathing exercises, can help individuals with BPD become more aware of their thoughts and emotions, promoting emotional regulation.
Journaling: Keeping a journal allows individuals to reflect on their experiences, identify patterns of thinking, and track emotional responses to different situations.
I’ve known a few humans suffering from BPD who credited journaling about their thoughts and feelings. Anais Nin never played by the rules, and her narcissistic corrosion of conventions is but dimly lit in her diaries (some call them liaries). But as a narcissist with borderline features, it helped her to self-reflect more deeply.
Interpersonal Effectiveness
Communication Skills: Learning effective communication skills can help individuals express their needs and emotions in a constructive manner, reducing conflicts in relationships. If you’re in DBT, I can help with that.
Setting Bo Coping Strategies for Individuals with Petulant BPD
undaries: Establishing and maintaining healthy boundaries is crucial for individuals with BPD. This can involve learning to recognize one's limits, communicate assertively, and negotiate boundaries in relationships.
Emotion Regulation
Identifying Triggers: Recognizing specific situations or events that trigger intense emotional responses is a crucial step in managing emotional dysregulation.
This requires something we all could benefit from more often; an observing self. A self who notices.
Coping Strategies: Developing a toolbox of coping strategies, such as grounding techniques, distraction methods, and self-soothing activities, can help individuals navigate challenging emotions.
This is where good DBT, individual, and couples therapy comes in.
I’ve had a few cases doing couples therapy with women who were repeatedly raped and impressed into sexual servitude by their biological fathers. I live in Western Massachusetts, which is a place where some men go to live unseen.
My first was as an intern. She was a 56-year-old “Borderline”, a cutter. Her father raped her repeatedly from the age of 5. I wrote about this case for my master’s thesis.
I had no fu*king business being assigned this case, and I protested mightily to my supervisor who ignored my protests. I was cowed by her suffering.
That’s why personality disorders scare off most couples therapists.
But it’s like Elvis singing “In the Ghetto…” We can feel empathy, but at the same time we know it doesn’t emerge from direct experience. Better to be Johnny Cash singing with the damned instead of to them.
Challenges in Diagnosing and Treating Petulant BPD
Stigma and Misunderstanding
Labeling and Stigmatization: The stigma associated with personality disorders, including BPD, can hinder humans from seeking help and receiving appropriate support. The term “borderline” originally described the borderline between sanity and insanity.
Is it any wonder that the term borderline is synonymous with screaming harpy nutjob?
Lack of Awareness: Both within the general public and among healthcare professionals, there may be a lack of awareness and understanding of the petulant subtype of BPD, leading to chronic misdiagnosis, or piss-poor inadequate treatment. I’ve seen too much of both.
Here’s the quiet part out loud. Couples therapists, as a rule, prefer highly motivated, emotionally regulated couples with clean hearts, and secure attachment.
While there are interesting thought leaders who have made careers focusing on conducting therapy with personality disorders, there are also humans who scale mountain cliffs with their bare hands.
Takes all kinds of brains to make our world, doesn’t it?
Comorbidities
Humans enduring BPD, including the petulant subtype, often experience co-occurring mental health disorders, such as depression, anxiety, or substance use disorders. Treating these comorbid conditions can pose additional clinical challenges, and may often require a treatment team.
Treatment Resistance: Some individuals with petulant BPD may be resistant to engaging in therapy, particularly if they perceive it as an intrusion or a threat to their autonomy.
This is the biggie.
The best way to deal with a narcissist or borderline is in stealth mode at a very oblique angle. They can not tolerate being seen as the “designated problem.”
And to be truthful, and fair to the “borderline”, there is often an aggravating context. At 19, I was passive-aggressive, deceptive, emotionally dishonest, and easily cowed. My behavior did not soothe BPD, it provoked it.
Advances in Neurobiological Research
Neuroimaging Studies: Ongoing research using advanced neuroimaging techniques may provide further insights into the specific neural mechanisms underlying BPD, including the petulant subtype.
Pharmacological Interventions: Continued exploration of novel pharmacological interventions targeting neurobiological dysregulation in BPD may lead to more effective medications. But nothing of note so far.
Tailored Treatment Approaches
Personalized Therapeutic Strategies: I suppose developing more individualized and tailored therapeutic approaches based on the specific characteristics of the petulant subtype could improve treatment outcomes.
This is what many therapists claim to do.. but some make it up as they go along, and then call it a tailored treatment.
Another reason why a treatment team approach is wise is the tendency for the tragic misdiagnosis of neurodivergent humans as having a personality disorder.
. I would remind them that clients with BPD are among the most demanding and potentially litigious. A treatment team approach is often, if not always, in the best interest of the client as well as the clinician.
Integrative Models: Exploring integrative models that combine various therapeutic modalities to address the complex interplay of biological, neurological, psychological, and social factors in BPD. This is where my best hopes reside.
Final thoughts…
Borderline Personality Disorder with the petulant subtype presents unique challenges and requires a nuanced understanding of its clinical features, theoretical underpinnings, and treatment approaches.
In candid moments, an overworked couples therapist might ask…Who has the time for that? We’re talking about a tiny fraction of humanity.
While progress has been made in research and therapeutic interventions, there is still much to learn and explore, I might add… too much to learn and explore.
Personality disorders metastasize down through the generations producing tsunamis of epic loneliness, grief, and despair.
We need to up our game for these poor suffering souls… and for the narcissists and borderlines they’re bonded to.
That’s the problem with all sorts of stigma reduction. When we talk about raising awareness, the notion of reducing stigma typically arises.
Stigma serves a social function. Someone has to name what is going on.
Let me use a little Cinema Therapy on myself. In Godfather III, the future Pope scolds Michael “ Your sins are horrible, and it is just that you should suffer!”
Then with a loving, forgiving look…just like that… Father Lamberto absolves Michael, a consummate narcissist, of his sins. Knowing, and telling him that he will not change… calling into question the nature of Michaels's poignant suffering as he confesses, as well as the act of absolution itself.
Michael did not confess to terrorizing and humiliating his wife, or having a prostitute, carefully selected for her solitude in the world, violently ripped to pieces to compromise Senator Geary.
I found Michael’s confession narcissistically focused on his family of origin. His greatest pain was for an act he took great care to delay, a delay which offered him plenty of opportunity for reflection.
Frankly, whatever Roman Catholic sensibilities remain in me are deeply offended. Michael’s confession seemed sacrilegious in its omissions.
I guess that’s why that was the most unsatisfying of this otherwise masterful trilogy. Michael’s redemption was too glib, hurried, and harried.
Living with, and loving someone with a personality disorder is a too common form of meaningless human suffering. Healing is a process that will sometimes struggle to find words, time, and motive.
There must be an airing of pain and grievance as an unfolding of a true healing process. The loved ones must be heard, and be availed an opportunity to understand. Otherwise, their suffering may echo through time and across generations.
It’s my hope that by advancing research efforts, we can contribute to a more comprehensive understanding of BPD with Petulant Features and perhaps improve the lives and redemptive power of the humans grappling with this complex mental health condition, and also the friends and family who still choose to love and stand by them.
Be well, stay kind and Godspeed.
