BPD Relationship Cycle: Working with Teenage Girls with BPD

The BPD relationship cycle can affect every aspect of life for teenage girls with Borderline Personality Disorder.  They never relax. They are in a constant state of crisis. As if life doesn’t hand them enough pain, they extend and expand that pain with their attempts to avoid the pain instead of work through it.

Relationships seem to cause them the most pain. Breaking up is hard to do! One of their favorite ways of avoiding the pain of a failed relationship is to fabricate another emergency so that they can forget about the crisis which besets them at the moment. They become experts at hopping from relationship to relationship; this way they never have to finish grieving the previous relationship nor resolve past predicaments. Ironically, all of their strategies for avoiding pain result in more pain.

Supernova Relationships

In her mind, romantic relationships are both the bane and the salvation of the teenage borderline girl! The fear of abandonment is so strong in teens with Borderline Personality Disorder, that they employ frantic techniques to keep boys from rejecting them. These techniques are shallow and insincere, frenzied and impulsive. Thus, they attract boys who will use and abuse them. This sets them up for failed relationships, which perpetuates their experience of frequent rejection. With no emotional anchor to ground them, teens with BPD flounder from relationship to relationship, like a sparrow bounced from gust to gust in a hurricane.

A supernova relationship is one that burns hot and bright for a time, then implodes like a dying star. People all around the borderline teen get hurt after such relationships, but the true casualty is the “star” herself – she acts out her pain upon herself in various ways. And none of her coping skills bring peace or relief.

16-year-old Marsha was euphoric. Her boyfriend had just treated her to a special birthday dinner complete with candlelight. What made it more romantic was that he had hung blankets in his parent’s unfinished basement, converting the bare walls into a cozy makeshift private dining room. It had been the best birthday she’d ever had.

That’s why it was so painful for her when she caught her supposed boyfriend kissing another girl the very next day.

Instead of confronting him, dumping him, and moving on with her life, Marsha began throwing herself into the relationship, doing everything she could think of to win his heart. She bought him expensive gifts. She made her body available to his every desire. When his deception continued, she became despondent and eventually hatched a plan to cheat on him to make him jealous. She found another boy, won his affections, and then made sure her boyfriend found out. When her boyfriend confronted her, they had an explosive argument; he hit her, called her a “slut,” and then dumped her.

In tears and anger, she went home and scraped her wrists with a sharp piece of metal, then called the boy she’d cheated with. She spent a passionate series of days and nights with him. Understandably, that relationship burned hot and then fizzled out quickly, prompting her to find yet another boy to assuage the loneliness and pain of being rejected twice in so short a time.

Reality Testing

Under extreme stress, teens with BPD can be out of touch with reality. They need an outsider’s perspective to re-orient them to truth and logic. Anxiety and emotion are effective at holding logic hostage, so the therapist must be skilled in first empathizing with the teen, and then gradually introducing rational thought.

Scaling questions can be effective antidotes for irrationality. “On a scale from one to ten, one being the lowest, how much did you love him?” If the answer is “ten,” the therapist can ask, “on a scale from one to ten, how much did he hurt you?” Again, the answer is likely to be “ten.” It then just requires a series of carefully constructed questions to help her reach the conclusion that if her boyfriend had loved her as much as she loved him, he would not have hurt her the equivalent of a “ten.” “On a scale from one to ten, how much did he love you?” “How much does he love you now?” “How much does he love his new girlfriend?” “How much do you love him now?”

The answers are less important than the object of the exercise, which to get her mind out of its irrational, emotional state and back into using logic to think through the current situation.

Rules

It’s usually her regret of having done certain sexual and physical acts with a former beau that brings the sense of shame and pain to the borderline teen after the relationship implodes. Teaching a borderline teen to establish rules for her relationships, especially sexual boundaries, can be empowering and protective for the teen. I often lead teens through a process of establishing sexual boundaries; a process I call “working backwards.”

The process of defining when they want to have sex is both frustrating and empowering. We’ll start working backwards by defining their “ultimate goal.” Some clients may want to wait until marriage to have sex. Some may want to wait until they have been together for a year. Even more common is their wanting to wait until it “feels right” or they are “in love,” which is too vague to be workable. Eventually, we come up with something like, “I want to wait until I’m his girlfriend, he’s met my parents, and I’ve been dating him for at least six months.”

Once she has defined her ultimate goal, I’ll lead the young woman through the creation of her personal physical boundaries. “If your goal is to wait until you’ve been his girlfriend for six months, you’ll need to avoid those powerful sexual activities that will make it too tempting for you to say no to sex. What are those?” She will describe oral sex, for example, and then we have our first rule: no oral sex.

This process continues, working backwards, until we have defined what she will allow in her relationships, and when. “Will you allow someone who is not your boyfriend to kiss you?” Another rule. “When will you first hold his hand – on your first date?” Another rule. And then it is a matter of coaching her as she attempts to follow the plan she’s laid out for keeping herself physically safe in relationships. As we all know, with a teen, mastery in the therapy office rarely translates directly into competence in the real world.

Situational Planning

The establishment of a BPD teen’s personal “rules of engagement” in relationships opens up a nice opportunity to discuss the personal damage she’s sustained due to prematurely extending too much trust in her relationships. She hurts herself by impulsively doling out trust and confidence to a partner in moments of pleasure or excitement. It’s helpful to teach her how to plan strategically to offer trust in increments, instead of offering it all at once only to be surprised and wounded by a rejection.

The acronym T.R.U.S.T. is easy to remember, and playfully teaches the teen a hard concept: when and whom can I trust?

T: Trustworthy – is he trustworthy in everything? Does he lie to anyone?
R: Respectful – is he respectful of his family members? Of the waitress? Of you?
U: Unconditionally Kind – is he kind to everyone, no matter their status? To you?
S: Safe – do you feel physically and emotionally safe with him?
T: Time – have you observed these behaviors long enough to really know him?

This is not a guaranteed way to know when or how to extend trust, but it provides a benchmark that a therapist can return to when discussing relationships in the future.

Grief Process

Of course, all of these techniques focus on the preparation for and prevention of pain. We must also teach the teen how to grieve what she loses when painful breakups actually occur. She will need to learn to cope with the loss of respect, companionship, love, trust, confidence, health, and success.

I’ve found it helpful to explain the grief cycle to a teen girl (denial, bargaining, anger, sadness, acceptance) in terms of a circular journey, rather than a linear event. I explain that she may return frequently to her tears and irritation. She may lose touch with reality in a moment of stress, and bargain once again for the affections of the one she lost. As long as she understands the cycle, she won’t berate herself so badly for “regressing.”

If she can learn to allow herself to grieve, she will move through the bpd relationship cycle faster and find relief sooner. For some borderline girls, this may be the first time they experience true relief from pain, and it is liberating!