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Are ‘High-Functioning’ People with BPD Less Likely to Seek Treatment?

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I began to educate myself on Borderline Personality Disorder (BPD) about a year ago, first by reading the popular book “Stop Walking on Eggshells” and then by supplementing that with other books and online resources. What motivated me to do so was the growing suspicion that my sister-in-law suffers from a mental illness of some kind. After discussing her behavior extensively with my own therapist and consulting other family members, we concluded that her patterns of behavior best matched the criteria for Borderline Personality Disorder.

More than once in the course of my reading, I came across the concept of “high-functioning” vs. “low-functioning” BPDs and became convinced that my sister-in-law fell into the “high-functioning” category. I believe this may be the biggest obstacle to her seeking Borderline Personality Disorder treatment.

High- vs. Low-Functioning BPD

If you are not familiar with the “high-functioning” vs. “low-functioning” concept of Borderline Personality Disorder, allow me to very briefly explain. A lower functioning person with BPD may exhibit more overtly troubling behaviors such as self-harm or debilitating depression, which are both obvious signs of serious mental illness and may preclude the person from holding down steady employment or performing day-to-day tasks. A “high-functioning” BPD may be more adept socially and able to perform in a work environment.

A “lower-functioning” BPD cannot hide the severe symptoms of their disorder and it is very likely that they will end up hospitalized or in the presence of a mental health professional at some point and be diagnosed or treated. On the other hand, a “high-functioning” BPD can often hide their disorder more effectively and are less likely to get needed BPD treatment.

Barriers to BPD Treatment

One of the things that resonated with me in “Stop Walking on Eggshells” was the recognition that many times it is only the people closest to the person with BPD who witness their most problematic behavior. When my brother reached a desperate moment about a year ago and reached out to his wife’s friends and family for support in dealing with her increasingly disturbing behavior, no one believed him. We had witnessed incidents by then of what amounted to child abuse, but when her parents (who live out of town) were informed, they chalked it up to moments of poor judgment. Her friends who were also mothers simply thought that my brother had no concept of how difficult being the primary caretaker actually was.

We had hit our first roadblock: those who only saw my sister-in-law socially or spoke with her on the phone occasionally had never witnessed her most extreme behavior. They hadn’t experienced the rages, the verbal and physical abuse, or the complete disconnect between her perception of events and what other’s perceptions were of that same event.

My sister-in-law remains undiagnosed by a psychiatrist and has sought no Borderline Personality Disorder treatment. After a marriage counselor recommended that she see her own therapist privately, my sister-in-law denied any need for that and then decided that she no longer wished to attend marriage therapy, either.

Her friends and family simply do not see what we see, but they do hear a lot of “projection,” which is how many people with BPD deflect feelings of guilt or avoid responsibility for their actions. They simply accuse others of exhibiting the offensive behavior. In her version of events, it is my brother who refused to amend his behavior according to their therapist’s recommendation.

I found out about Clearview Women’s Center a year ago and am still hopeful that one day my sister-in-law may have a breakthrough moment of self-reflection and enter Borderline Personality Disorder treatment. Until then, our family is fractured and we suffer as much as she does with Borderline Personality Disorder.

Contributed by Alicia Danielle.

13 Comments

  1. Inez Mond

    I know this is cruel, but still: I hope you have a severe major depressive episode one day. Then you’ll understand what’s so horrifying about your claim that you’re suffering as much as your sister in law. It’s amazing how skilled people are at finding a way to blame the victim when faced with clearly organic mental illnesses like depression, bipolar disorder, or severe anxiety. Would you act the same way if it was Huntington’s disease that destroyed the parts of her brain responsible for impulse control?

  2. I’ve heard this one before. Person A doesn’t get along with person B, and seeks out information on the net or in books and then proceeds to diagnose person B with a personality disorder, usually of the NPD, BPD or ASPD variety (or, if they’re feeling especially omniscient, all three of them!)

    If her friends and family “don’t see” her disordered behavior, maybe it’s because 1) she doesn’t even have the disorder and/or 2) just really does not like you on a personal level, but is “okay” with the rest of her family and friends.

    A personality disorder is a pervasive pattern of behavior across various contexts, not just with a sister-in-law. School, work, family, romantic relationships are all affected.

    Ergo, there is no such thing as someone with “invisible” borderline personality disorder.

  3. Doug Kneeland

    Natasha: My experience has been that you are quite seriously mistaken.

  4. Speaking from experience, publicly shaming a sibling’s abusive spouse is a reeeeeally good way to get cut off from your brother and his kids:(

    Why not refocus your family’s efforts on what you all can do “behind the scenes”, to actively support the well-being of your brother and his children? Help him figure out what he has to do to get sole custody? Offer to babysit? Etc.?

    At the end of the day, it really doesn’t matter what her diagnosis is… She could be a diagnosed sadistic psychotic sociopath, or just your garden variety, disorder-free abuser.

    Your brother will still need to go through the same steps to protect himself and his children.

  5. I believe what happens to your brother is true. A high-functioning borderline person will have less resistance to treatment if she feels the great loss as a consequence of her own impulsive action. My wife seems to have this disorder. I have kept my mouth shut and have been waiting for years for an opportunity. Recently, an issue happened in her family. I successfully persuaded her to see a therapist. I’ll encourage her to maintain in treatment.

  6. This article could have been written by my friend. It took her brother recording what was happening in his family and showing it to the police, who issued an emergency protection order against his wife, before the wife accepted that she needed counselling for BPD.

  7. Same thing happened to me. My 13 yr old son recorded one of my ex wife’s rages and it was used as evidence in court. The Court prior to this assumed I was the abuser, but then overturned everything and she had to undergo a mental health assessment.

    Even though we are now divorced and I’m the main child carer I still make excuses for her behaviour as I understand the pain she must be going through every day. My family and friends are less forgiving as they don’t believe her behaviour is due to inner termoil and assume it’s just malicious.

  8. What if the High-Functioning BPD condition is the (re)activation of otherwise tamed BP traits due to exceptionally difficult circumstances? Like a drug addict’s wife who would oscillate between extreme devotion to try and save her husband and episodes of rage when he disrespects her efforts and fucks up again. The drug addict husband would then blame his undiagnosed or self-diagnosed high-functioning BPD wife for his own failures: “After all the rage I’ve endured from you, of course, I’m an addict who can’t recover. But I’m not important enough for you to seek therapy instead of educating yourself on the matter because you’re high-functioning and no one else sees this, I’m heartbroken but you don’t deserve another shot at trying to help me.”

  9. Inez and Natasha are gravely mistaken.

    Inez, people with depression don’t slander and abuse. We need to stop enabling abusers. There is no excuse for abuse. Anyone who abuses has SOMETHING wrong with them. Childhood trauma, a personality disorder, etc… what’s the criteria for accepting abuse?

    Natasha, loved ones of people with BPD don’t just experience abuse, it is abuse and instability of a bizarre nature. The specific nature of the patterns of abuse (very childlike, slander, playing victim, warping events etc..) and triggers (fear of abandonment, splitting, etc…) are easy to spot and diagnose. You don’t need to be a doctor. There very much is a thing called a “Transparent Borderline” and it is a complete nightmare for the partner. I would argue the worst kind.

    My wife is a “Transparent Borderline.” She is so cunning in her slander of me with her friends and family. By the time it comes to a point where I need help in some sort of intervention: there is no one but me who is aware she needs one and she has already painted me as the abuser to everyone else, even her therapist! Who, by the way, has “Ruled Out BPD” within only a few sessions of only talking to her (the person who is skilled at slander and manipulation) only to further enable her.

    The partner of a “High-Functioning, Transparent BPD” gets abused and then accused by everyone in the borderline’s circle! And being the only one meeting the BPD’s higher standards for idealization (and the devaluation that inevitably follows) you are left with nothing to defend yourself with, because you took the high road and didn’t hide a camera somewhere. No one else has experienced their full rage. Oh, their friends and family may admit they’ve seen them go a bit over board, etc… but a mental illness? “You’re mentally abusive for even suggesting someone is mentally unstable.” Also, their high-functioning life and circle of friends and family (whom they don’t have conflict with) only further validates their warped world view. “I only have conflict
    with him. He must be the problem.”

    In my opinion, the worst part of a “Transparent BPD” is that they are stable enough to love. They are just stable enough to give you hope. You’ve seen them improve and admit they’re wrong (at least relative to their previous crazy). You even get them to agree to seek help as an ultimatum when things really hit the fan. This gives you hope. This makes you think, “if only we get the right help.” But, then it’s “I won’t go as a couple to therapy because you’ll just try and convince them it’s all my fault.” You play along and admit to partial blame only to aid in their gas lighting and making themselves the victim. She seeks help, but finds a therapist who parrots “in a relationship there’s always 2 people to blame” and falls prey to her slander and manipulation. He thinks I’M the gaslighter! These therapists are so ill-equipped. “Well, no cutting, drugs, or suicide. They haven’t fallen in love with me yet. Cannot be BPD.”

    What can you do? How can you win? We are separated so I can’t take footage. She has footage of me yelling and texting out of context. Angry because I was being abused. She even took pictures of bruises on her arms. Bruises she sustained from me defending myself from her beating me (I grabbed her arms). I had to leave, she had been slandering me to the police and her neurotic father (no doubt the source of her BPD) comes over to harass me.

    Is there even any hope for a “High-Functioning Borderline?” I’ve read that claims of BPDs improving are slanted, in that they really just stop drugs, cutting, etc… it’s rare that they ever graduate to having stable, healthy relationships. It’s really a matter of the partner learning to pacify. Can they actually improve with proper help? or am I just wasting my time.

    I love her very much and can see she is a loved one with a problem despite all she has done to me. What are my options?

    PLEASE email me: joshualevan@gmail.com if you have had a similar experience or any answers. Thank you.

  10. Joe Smith

    Dude, I was married to high functioning BDP wife for 26 years. I filed for divorce and you should too. Why are you staying ? Love is a 2 way street in a marriage. You are wasting your time. Anyone who allows someone to abuse them has SOMETHING wrong with them.

  11. Joe Smith,

    I have indeed divorced her. It is very difficult. I love her very much, but I know it was the right course of action. In talking with a therapist who actually listens to me, we have come to the conclusion she is also a narcissist. This aspect makes her pretty much impossible to treat or improve. In fact, it was her Cluster B traits that made her so charming and “loving” in the first place. It was all an illusion. A ploy to wrangle me in so she can toss me out. A mask.

    Not only was I abused and lost a loved one, the love was never there to begin with. It is devastating. A “high functioning” BPD, has even more room and power to slander you and make you look like the bad guy. Especially if she is a woman and you are a man.

    These people are toxic and evil.

    BPDs have aspects of all 10 personality disorders and commonly have more than one. Keep that in mind.

  12. Unfortunately, there is no way to deal with a person with a “high functioning” BPD. You cannot win and it is hard if not impossible to convince others that they are what they are. The only ones I know of who have participated in therapy did so to get better at manipulating others and identifying other’s vulnerabilities.

    It is often difficult to realize that you can love someone and not like what they are doing. However, acceptance is acknowledging the fact of the facts whether you like it or not. A “high functioning” BPD can be the most entertaining, fun, attractive, and popular people you will ever meet. Behind closed doors they can be the meanest, cruelest, and most harmful people you will ever know. In some ways the worst part is they do not chose to have the disorder. They are born with it and die with it. As they get older they begin to de-compensate and everything gets worse.

    I have a sibling with a “high functioning” BPD, who destroyed my career and turned my friends against me based on false statements and outright lies.

    One interesting symptom I have noticed is that often she believes her own internal self-talk and then acts on it as reality. When confronted she will change the subject and you think you missed something. They will turn “facts” into “feelings” when confronted with their false reality. When I confronted her with emails containing false statements about me, she responded with, “You don’t love me.” and left the room. The fact is that I do love her but I do not have to be hurt all the time. I can lover her from afar.

  13. I have finally discovered after 20 years of thinking my wife was just an alcohol abuser
    add in the superiority,cheating,stealing huge amounts of money from me and my parents, lying,denial,aggression,manipulation,lack of affection towards me and the kids,needing to be center of attention in social situations when drinking,high turn over of friends, verbal abuse to me and the kids…and wait theres more
    …..dont really need any more at this point the point is I was told by several Councillors and a friend of a friend it sounds like a personality disorder so did lots of research and BPD fits the bill
    then this morning saw something on high functioning then transparent BPD which led me to this site Joshes story rings closest to mine so we are separated in the same house which I believe is not good for the girls they are only 8 and 12 so need to break away sounds like !!! thanks for any advice

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