Emotional dependence in borderline personality disorder

In another article I wrote about how borderline personality disorder (BPD) is treated, so it’s about time I came back to it, because as well as being very complex it’s a really interesting subject to discuss from a clinical point of view. Today I’m going to focus on one of the most typical manifestations of the disorder: emotional dependence.

Ways of filling the void

People with BPD generally feel a great emotional emptiness, which they experience with a lot of distress and a sense of not being understood. They try to fill it at any cost and in many different ways, many of them unhealthy, which, without their realising it, leads to greater emotional chaos that only makes their mental health worse. How do they usually try? I’ll explain briefly below.

That boredom with life leads the person with BPD to seek out strong emotions in order to fill the void they feel. They can do this in all sorts of ways, from extreme sports to falling into all kinds of addictions.

They often try to fill this void by looking for a partner, trying to find outside themselves something they ought to be working on within. Looking for a partner at any cost often means the patient ends up with the wrong person, which leads to more problems. Something these people often do is idealise the other person, put them on a pedestal, and of course what usually follows is a deep sense of disappointment, which sets up a pattern of intense, short-lived relationships. Others, despite overwhelming evidence that their “other half” wasn’t what they thought, stay in the relationship even at the expense of their physical and/or mental health. These cases usually hide a deep fear of never finding anyone who will love them.

Another way of showing emotional dependence is through casual relationships based on sex. What these people are really looking for with this behaviour is the other person’s affection, but because they believe they don’t deserve it, they limit themselves to sexual relationships.

At other times emotional dependence shows itself in a very different way: by taking charge of another person, that is, taking on the carer role and putting themselves second. What they’re really doing is caring for the other person the way they would like to be cared for.

Some patients with BPD focus on being the centre of attention wherever they go. This is a more superficial form than the others, but the aim is exactly the same: to feel less empty, even if it’s through social conquest. What matters is being the centre of attention, and if that means being provocative and making hurtful comments, they’ll do it. That said, they generally prefer to be in the spotlight for good reasons.

Finally, there’s the person who tries to fill their emotional emptiness through social acceptance, adapting like a chameleon in order to be accepted and loved by others, even if it means sacrificing their own values and needs.

How we work on it in therapy

As you can see, the ways people with BPD seek emotions are extremely varied, but we mustn’t forget that they all point in the same direction.

For those who try to fill the emotional void with strong emotions through addictive behaviours, we’ll focus on redirecting the way they seek those emotions, for example by helping them find hobbies or even careers that can to some extent meet that intense emotional search. Applying stimulus control is also important in these cases.

As for those who try to fill their emotional void by looking for a partner at all costs, we’ll teach the patient to build healthier relationships with other people. The person with BPD needs to learn that they can have relationships at different levels, and not all of them have to involve a high degree of intimacy. We’ll need to work in depth on improving social skills, increasing frustration tolerance, and building realistic expectations about what to expect from different social interactions and from people in general. In short, in-depth work on human relationships at different levels and in different contexts.

For those who take on the carer role, it’s essential to work on the idea that they matter too, so part of the therapy will focus on detaching a little from the other person and giving themselves more priority. In this particular case, expressing negative emotions is also usually something to work on, as these tend to be suppressed by the belief that “I can’t / I have no right to”. Assertiveness in general will be key with carer-type BPD patients, especially the part that involves learning to say “no”, as it will with those who seek social acceptance at all costs.

As for those who seek to be the centre of attention, we’ll also focus on social skills and on teaching the patient to step back into the background from time to time.

If you’re interested in the subject, I recommend having a look at the book Vivir con el trastorno límite de la personalidad (“Living with borderline personality disorder”, Desclée De Brouwer, 2017, available in Spanish), edited by Álvaro Frías. It’s an accessible book that works both for professionals and for the general public, and gives a fairly useful overall picture of the disorder.