The Email:

I have a sister who is borderline. She has a couple of friends who are borderline. What they all seem to share in common, among other things, is this distrust and hate for their doctors. Why is that? No matter what I try to say they just don't even want to consider that the way they "hate" their doctors is counterproductive for them. Any thoughts?

AJ's Response:

It is difficult to say in any individual way why they would hate their doctors. However, relationships of any sort can be very complicated for those diagnosed with Borderline Personality Disorder (BPD). Lack of trust and a high degree of both suspiciousness and defensiveness likely add to the mix where these feelings are concerned.

Many who are borderline have tremendous difficulty with authority and authority figures. I suppose there may well be as many reasons for this as their are borderlines. The fact is that to many with BPD the doctor, particularly the psychiatrist they may see represents authority and may be seen by the borderline has having too much "power". This perception of another having power, for many borderlines, will equal their feeling they don't have any power. This is due to their black and white, all-or-nothing thinking.

Another factor in this may involve the fact that there are still many out there with BPD who for whatever reason have not yet been able to grasp that they have to be responsible for themselves. It is this abdication of responsibility that leaves borderlines helpless, not the authority or power of any doctor. Yet many who are not able to take personal responsibility basically (illogically) expect the doctor to change them, to make things better, to give them the "right" pill, to cure them, to end their pain. No doctor can do this.

Of course another reason borderlines may often express hatred for their doctors may involve transference and projection. Often the doctor will take on the role of a parent or some other significant person in the borderline's life who did not meet the needs and/or expectations of the borderline. "Splitting" is a big reason for such strong feelings. Hate is often a defense as well. It is a way of distancing and of remaining disconnected as well.

The degree to which hating a doctor is counter-productive is questionable. Of course it most definitely can be counter-productive. Sometimes, however, it may be what is necessary in order for the person with BPD to work out certain rejection, abandonment, authority, trust issues etc etc.

The act of truly hating a doctor though is counter-productive to trying to forge the kind of trusting relationship that is most conducive to a positive therapy experience.

Many borderlines are very rigid in their thinking. I doubt whether you will be able to talk them out of what it is that they believe they feel for their doctors.

This response is © A.J. Mahari

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