Tuesday, September 24, 2013

Borderline Personality And Splitting

Though the term "splitting" is misused often by line staff, it is indeed a symptom of Borderline Personality Disorder. In the confusion over the boundaries of what is BPD, what is PTSD, and whether someone has a full Personality Disorder or simply traits, lines are hard to draw. All this granted.  But splitting, the psychiatric symptom, does indeed lead to "splits" in the staff of how a patient should be handled at any given point.  Some are moved to rescue, some to punish.  Default opinions about What Should Be Done are frequently appealed to, with staff slowly being maneuvered into acting out the patient's split - their either-or thinking by engaging in unlistening, either-or behavior themselves.

But it is not the patient's actions which create the split amongst the staff.  Those maneuverings and attempts to externalise inner conflict into the actions of those around reveal staff conflict, not create it.

This diagnosis-specific knowledge has more general application to all "difficult" people, such as the ones you work with or live with.  You might examine whether they are creating the conflict in the office, the church, the neighborhood, the family, or are they simply revealing a split that is there anyway?


Donna B. said...

In more 'informal' settings these people are called "pot stirrers". I suspect that moniker can be applied to the equivalents of both the patient and the staff.

I'm speaking of family/church settings. Those have been closely related in my life's experience.

As for what happens in psychiatric settings, the best I've seen is benevolent nonchalance. Granted, the few times my son got admitted to "psychiatric hospitals" that actually had professionals on staff, family was not invited to participate and this was mostly my son's decision.

The rest of the time -- the majority of the times -- the staff was minimum wage, high school educated herders and gate-keepers. The one professional -- the psychiatrist -- who contracted to the facility showed up once a week to write prescriptions.

Those facilities where multiple professionals (like yourself) worked together were almost always state run facilities.

The unfortunate thing that happened to my son was that in our geographic area, those facilities have become almost exclusive to indigent/Medicaid recipients.

Anonymous said...

I guess most people are splitters; it's just a matter of how strongly we feel about something. Discussions about death penalty and abortion tend to lack nuances. It's possible that people with BPD, who often seem very intuitive, can spot conflicts and sensitivities in others and fuel any potential drama in people around them.