This article is published in the book:

"Psych 101 -
What you didn't learn in nursing school."


by Kathi Stringer
Paperback: 320 pages
ISBN-13: 978-0615193137
Order
   

Manipulation and the
Borderline Personality Disorder

Written by Kathi Stringer

What exactly is manipulation, and are individuals with borderline personality disorder capable of this sort of exploitation?

This area of discussion is thought provoking and has been tossed around quite a bit. Usually the prominent mental health professionals agree that a person with borderline personality disorder is a very poor manipulator (Gabbard, Linehan, Mason and Iowa model). They are indeed so pitiable at management of their behaviors that it often lands them into trouble. For this paper it will be useful to separate cognition from behavior to isolate manipulation.

Cognition

Manipulation is defined as a deliberate thought process. Not behavior, but thought. A cognitive, shrewd, artful….planning, setting into motion a plan, an idea and make that idea a reality. Scientists manipulate genes, lab rats and additional parameters, skillfully and deliberately. Not as a reflex. When the mind is skillfully forming specific algorithmic (step by step) instructions, then we can call this manipulation.

Reactive Behavior

Manipulation is a response, not a reaction. Knee-jerk is a reaction. Again, we go to the definition of the word. Manipulation is defined as a thought process, not a behavior process. Behavior is only the product.

This product of reaction, a sort of pseudo-manipulation is usually activated when an individual with borderline personality perceives impending annihilation, disaster and abandonment. This hypersensitivity may stir up tremendous anxiety and helplessness.

Helplessness

Most people with a borderline personality have not successfully moved though their early developmental stages and are fixated usually around 2 to 4 years of age. Impulsivity is a prominent behavior that is often misinterpreted as manipulation. A person with borderline personality may experience anxiety as helplessness since she cannot equate her notions to an adult on an equal level. As one person living with an individual with borderline personality stated,

“I suspect that the BP at this point is in maddening, excruciating emotional pain and confusion.”

Her take on this portrays helplessness especially well since time becomes narrowed and pressured giving a sense of urgency to resolve the pain. This sets into motion a reactive reflex (pseudo-manipulation) to ward off anxiety with often-destructive consequences. These destructive measures amount to job loss or relationship failure due to poor strategies to resolve antithetical troubles, hardly an artful and shrewd manipulation of a mastermind.

Barry Kiehn and Michaela Swales Stated:

“Linehan has a particular dislike for the word "manipulative" as commonly applied to these patients [borderline]. She points out that this implies that they are skilled at managing other people when it is precisely the opposite that is true. Also the fact that the therapist may feel manipulated does not necessarily imply that this was the intention of the patient. It is more probable that the patient did not have the skills to deal with the situation more effectively.”

The Iowa model

University of Iowa Department of Psychiatry; The STEPPS Group Treatment Program for Borderline Personality Disorder stated:

"Rather than viewing themselves [individuals with borderline personality disorder] as someone who is attempting to manipulate, is attention-seeking, or is sabotaging treatment, the trainees [individuals with borderline personality disorder] learn to view themselves as driven by the disorder to seek relief from a painful illness through desperate behaviors which are reinforced by negative and distorted thinking."

A borderline personality has the ability to manipulate, however; it is not the principal process of artful cognition that leads to borderline-style behavior. If we are going to use the term ‘behavior’ then it is more parallel to defensive behavior. Most of the time a borderline adapts to defensive behavior rather then manipulative behavior. There is an immense differentiation between primitive borderline defense mechanisms and skillful manipulation, the product of each, which is behavior.

Co-morbid Axis II diagnosis

What comes to mind is the Narcissist who co-opts others to carry out her functions. For example the narcissist doesn’t have the ability to feel empathy for others, and uses others as her narcissist supply, needing constant approval, strokes and identity assurance. The narcissist personality is not what society assumes, having a ‘big ego, just the opposite, they use the ego (executive of the self) of others because they are truly empty. Once these needs are not getting met any longer, the narcissist personality will easily dump the target and move onto the next. Quite different from the borderline personality, a narcissist personality is extremely good at manipulating, and their defensives are more advanced then the borderline personality.

It is helpful to consider that often times a person that has borderline personality is a ‘mixed bag’ since comorbidity traits in patients with borderline personality disorder is high. However if borderline personality disorder is the principle personality structure, chances are they are poor manipulators.

Treatment Team Awareness

Multidisciplinary staff and treaters would jeopardize the therapeutic alliance if they did not have a clear understanding of the borderline personality defenses. This is why countertransference management is important. Borderlines can make a treater’s veins budge out of the side of their necks, in a snap. As one treater recommended, “remove the hook.” Much easier said then done, it takes practice. Once a treatment team realizes that a borderline personality reacts, rather then the assumed fraudulent observation of manipulation, a strong therapeutic alliance is easier to construct since manipulation engenders hatred from the professional community.

Conclusion

Manipulation is a deliberate and artful thought process, which is not a common trait found in the borderline personality. The borderline personality defense is closer a Reactive Defense Mechanism that operates as a knee-jerk retort flung into motion from a low threshold of impulsivity. Identifying the difference between manipulation and reaction to painful stimuli can help ameliorate the therapeutic stance.

References

1. Cognitive-Behavioral Treatment of Borderline Personality Disorder - M. Linehan
[Book Link]

2. Skills Training Manual for Treating Borderline Personality Disorder - M. Linehan
[Book Link]

3. The Iowa model

4. Barry Kiehn and Michaela Swales at http://www.priory.com/dbt.htm
[Page Link]