Updated: Nov 15, 2022
The most active group of individuals that has the highest incidence of suicide attempts, and suicides are people diagnosed with Borderline Personality Disorder. Mental health professionals call this a phenomenon, while the drug companies invest time and money attempting to develop a medication that will reduce incidence of suicide. A sad fact is that antidepressant medication improves mood enough for an individual to exit the state of shame into apathy, only to have enough energy for a successful suicide attempt.
There are different ideas about how BPD develops, one suggestion is that people learn to understand and describe their internal states through reflective communication with others. This happens when a caregiver consistently comforts a crying baby, or makes an effort to resolve an upset state. This emotional process advances as a child ages, and the parent has to be more vigilant in reflecting back what a child is thinking and feeling, for example, if a caregiver witnesses a child stub their toe and responds with an acknowledgement of that child's feelings of pain and hurt, the result is that the child's emotion is validated. On the other hand, emotional neglect in the parental process contributes to confusion about inner emotional states.
Alexithymia is a term created in 1973 by psychotherapist, Peter Emanuel Sifneos, that relates to a condition he described as difficulty in identifying one's feelings and finding words to describe them. Sifneos's patients with alexithymia showed little capacity for imagination, had trouble distinguishing feelings from bodily sensations and their thinking style was focussed on external events with obvious avoidance of inner experience. The bottom line about Alexithymia is that it may derive from childhood trauma, or from negative caregiver interaction. On that note, emotional processing deficits associated with Autism Spectrum Disorder show high comorbidity with Alexithymia, and appear to be due to comorbid Alexithymia rather than Autism Spectrum. (Goerlich 2018; Bird & Cook, 2013) Research indicates that individuals with Alexithymia have continuous problems processing their emotions cognitively, as well as regulating them.
The theory of Mentalization Therapy, a therapy created for the treatment of BPD suggests that children develop a sense of self through the mirroring interactions of parents, and caregivers. It's when this communication about feelings gets misconstrued that a child may become confused about who they are. This confusion regarding the self is prevalent when caregivers misinterpret personality traits, and mood states based from their perspective. An example of this is being told you are quiet and shy by your primary caregiver, when in actuality you were withdrawn from living in an abusive environment. When caregivers fail to reflect correctly an individual may have a tough time developing a stable sense of self, and identity. This evidence is consistent from toddlerhood to the completion of adolescence. Adolescents are particularly vulnerable emotionally when they are developing a sense of identity between age of ten and nineteen. It is this time when symptoms of BPD may be prevalent if an adolescent has not developed the ability to calm or identify emotional turbulence.
The problem with inaccurate mirroring is less about us than it is about the person doing the reflecting. If a person were to base how they feel about themselves on inaccurate reflections, one could end up with a psychiatric condition. Anthony Bateman and Peter Fonagy (2004) use the term alien self to describe the part of the self that is developed based on inaccurate mirroring from others. According to their supposition the alien self is different from a person's true image, in that it often reflects a negative image, and the negative feelings reflected back to us through caregivers, and others throughout life. This alien self will not only be a conflict with who we are, but will be disturbing depending on the degree of misinterpretation by others. The sad reality is that people tend to do everything in their power to separate themselves from the false self that gets created, unfortunately some people lose their lives in the process of trying to rid themselves of the horrific feelings that make up the alien self.
The bottom line is this, the alien self is all about what is perceived about what others think, and project. It is about someone else's feelings, and beliefs about who and what we are. While this alien self can feel controlling, common reactions include pushing it out into the external world by projecting it onto someone else, this can produce more negative projections back to the source. Lack of awareness of the alien self can create a world that is as unpleasant as the shameless caregiver unaware of their own threatening projections of anger, and hostility. Seek Bindu - the point of creation.
Goerlich, Katherina S. The Multifaceted Nature of Alexithymia - A Neuroscientific Perspective; 29 Aug 2018 Frontiersin.org
Chapman, Alexander L. PH.D., Gratz, Kim L. PH.D., The Borderline Personality Disorder Survival Guide, New Harbinger Publications, 2007
Bird, G.,and Cook,R. (2013). Mixed Emotions: the contribution of alexithymia to the emotional symptoms of autism. Trasnl. Psychiatry 3:e285. doi:10.1038/tp.2013.61
Bateman, A. W., and P. Fonagy. 1999. Effectiveness of partial hospitalization in the treatment of borderline personality disorder: A randomized controlled trial. American Journal of Psychiatry 156:1563-69.