Ask a psychotherapist

June 4, 2015 · 0 Comments

Question from last week: My younger sister has always been “different”. Even as a kid, she got her way by making scenes – sobbing hysterically over small stuff or getting mad and not speaking to you for days, sometimes weeks! My parents gave in to her a lot just to keep the peace. She would make BFF and then suddenly dump them and never speak to them again. She can’t seem to hold a job or keep a relationship for very long because of her emotional outbursts. She used to wake our parents up in the middle of the night hysterical about something and threatening to kill herself. Now that our parents are gone, she’s calling me instead! I don’t know how to help her and I’m a nervous wreck. I dread hearing the phone ring. What’s going on with her and what can I do?
Answer, Part Two: Last week, I mentioned but didn’t explain the difference between two types of personality disorders: Borderline and Hysterical (Histrionic). Sometimes it’s difficult for a family member to distinguish between such disorders because many different types of underlying mental illness can lead to similar symptoms.
People with both disorders can be wildly emotional with abrupt changes in mood. Both are highly reactive to the behaviours and often misperceived emotions of others. Both desperately fear abandonment by important others and yet engage in “testing” behaviours (angry demands, excessive emotional displays among other things) that too often result in the very thing they fear. People with both disorders often experience themselves as empty and desperate for connection and the undivided attention of others.
But the differences between these conditions are also significant. A person with full-blown Histrionic Personality Disorder at first appears charming, vibrant, excessively concerned with appearance and sexually provocative; she/he focusses intently on one or more persons for a time and then suddenly abandons them and moves on. Someone with Borderline Personality Disorder swings between idealizing and devaluing others, often the same person on the same day. People in relationship with him or her may feel persistently criticized, devalued and controlled. And while people with this disorder easily attack, they are so sensitive to criticism themselves that others feel unable to defend themselves or fight back.
Another way to understand the distinction is to consider how you feel in relationship with this person. If you feel elevated and alive in their presence early on and then crushed by their later coldness and abandonment, you’re probably dealing with someone on the Hysterical (Histrionic) spectrum. If, on the other hand, your self-esteem and self-confidence are being continuously eroded in spite of the occasional good time with this person, they’re more likely on the Borderline spectrum.
Key to dealing with people on both spectrums is to maintain firm boundaries about the kinds of behaviours you will accept. Both conditions can be successfully treated in long-term psychotherapy with a therapist who offers Dialectical Behavioural Therapy (DBT). People like you who live with someone with one of these conditions also can benefit from psychotherapy that supports you in maintaining adequate boundaries and helps you to recover your wounded self-esteem.