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Section 12
Track #12 - Tips for Surviving Criticism, Unworthiness, and Helplessness

Question 12 | Test | Table of Contents | Borderline
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On the last track, we discussed several coping strategies for BPD clients that utilize self-talk slogans.  We categorized these lists of self-talk slogans into stages of anger arousal. These stages are  reassurance; triggering; physiological tension; and digressing.

As you know, BPD clients use anger as a tool for many different things. Some use it as a manipulating device. Others still use it as a defense. As we discussed on track 2, this defense is learned early on in childhood and is triggered by certain perceived threats to self-esteem or safety. 

On this track, we will examine the various triggers of defensive anger. These triggers are criticism; fear of unworthiness; and helplessness.

Three Triggers of Defensive Anger

Trigger #1 - Criticism
The first trigger is criticism. As I have found in my work with BPD clients, those suffering from borderline personality disorder have a difficult time accepting criticism, whether constructive or not.  The BPD client will often interpret criticism as a direct threat on his or her own person and will react accordingly. The source and importance of the criticism is irrelevant. To a BPD client, any manner of disapproval will incite feelings of hurt, fear, and self-consciousness. 

I have also found that BPD clients who are especially sensitive to criticism were subjected to extreme censure as a child by an authority figure, perhaps a teacher or a parent. When these feelings of wrongness or imperfection arise again, the BPD client will defend his or herself the best way he or she knows how. Stacy was a 23 year old client who had just become an RN.  When the time came for her three-month evaluation, her head nurse praised her for her energy, potential leadership abilities, and her warm and professional interaction with the patients.

However, the head nurse also included this line, "When Stacy gets behind in her work, she sometimes becomes rushed and careless. She needs to develop time management skills."  Despite the mountains of praise, Stacy’s mind focused on this miniscule bit of criticism. She became so angry, she almost quit her job. Stacy said, "I was thinking to myself, ‘My god, I do my best but it still isn’t good enough. What the hell do they want from me?  Screw this, I don’t have to take this!’ I was out of control. Thank god my sister stopped me from making a huge mistake." 

Technique.  Tips for Surviving Criticism
To help Stacy accept criticism, I gave her the following "Tips for Surviving Criticism" to help remind her what kind of criticism to take and what kind she didn’t deserve.  The list included the following techniques.

  1. Limit the damage.  This is in reference to an abusive situation.  If someone verbally batters you by calling you names or labeling you, it is your responsibility to leave the situation.  Do not react to the verbal abuser by escalating the conflict.  Take a time-out.  Also, remind yourself that this is just one person’s opinion about one aspect of your behavior, not a judgment of your character or who you are.  Finally, accept the fact that perfection is impossible.  Even if you are extremely competent in what you do, there is always room for human error which can be the result of various factors:  exhaustion, distraction, or feeling rushed. 
  2. Probe.  This is in reference to constructive or valid criticism.  During this kind of criticism, the best way to grow as a human is to get every piece of advice from the person that you can in order to avoid future mistakes.  Make sure you know exactly what the critic means, but ask them in a neutral tone of voice, without sounding defensive or aggressive.  Most importantly, do not intimidate the other person with anger.  Also, if the criticism feels to heavy or hard to take, you can still remove yourself from the situation and come back later to solve the problem.
  3. Deflect. Clouding is one deflection technique.  This involves agreeing in part with the criticism without accepting it completely.  Listen carefully to the critic, agreeing with the parts that are accurate.  Also agreeing in probability is another way to deflect criticism by using statements such as "It may be…" or "You could be right…".  One last technique for deflecting criticism is assertive preference.  In this technique, you agree to the criticism, but state that you prefer to do it your way anyway.  Acknowledge the difference of opinion and move on.

Think of your Stacy.  Could he or she benefit from "Tips for Surviving Criticism"?

Trigger #2 - Fear of Unworthiness
Another trigger for defensive anger is the fear of unworthiness. Obviously, this can be brought on by criticism as we just discussed, but also by abandonment. As you know, clients with BPD usually have suffered through a loss early in childhood such as a death or even something as simple as a divorce. Also, many BPD clients have an innate sense of badness or evil.  The client consistently believes that he or she is not worthy of love or affection and often uses anger to push people away before they have a chance to hurt the client. 

Stephen was a 21 year old BPD client who felt this strong feeling of unworthiness. Often, he would react to a joke of jibe with inappropriate comments about his uselessness or badness.  When Katie, his good friend, jokingly said, "Stephen, don’t be such a douche" Stephen responded in all seriousness, "Well, I’m going to hell anyway."  Although his anger was not aggressive, Stephen was using his anger to either find a confirmation or contradiction of this statement. 

To help clients like Stephen, I often ask them to make an "Affirmation List" or a list of twenty things they like about themselves.  For some of his affirmations, Stephen wrote, "I care about others’ feelings" and "I have a friendly smile."  I then ask Stephen to read his list twice a day so that he sees a contradiction of his badness in his own words.  Think of your Stephen.  Could he or she benefit from an "Affirmation List"?

Trigger #3 - Helplessness
In addition to a defense against criticism and unworthiness, the third trigger for defensive anger is helplessness.  BPD clients use anger against feeling helpless in two ways. 
--1. First, the client puts all of his or her energy into the failings of others.  He or she becomes occupied with the selfishness or mistakes of other people that they do not have to face their own impotence. 
--2. Second, when a BPD client shifts the blame to other people, he or she does not have to take responsibility for his or her failings. 

Lisa preferred to put the blame of her failed relationships on her ex’s inability to commit. The loneliness she felt was somewhat diffused when she could point the finger at her commitment-phobic boyfriends.  Lisa stated, "They couldn’t take affection and were too much of a pussy to handle a woman like me." Lisa never thought for a moment that her own impossible demands were the cause of the breakups. First, I asked Lisa to recall the her own behaviors during the relationship. I wanted her to accept responsibility for her loneliness.

I asked her to consider whether or not any of her actions might have pushed the other person in the relationship away. Finally, Lisa stated, "Well, I may have been a bit pushy." Once she had acknowledged that she was responsible for her loneliness, I asked Lisa think of ways of remedying this behavior.  She stated, "I could be less attentive and give them their space when they need it." I asked Lisa to continue to reconsider her actions in a relationship.

Think of your Lisa.  Could he or she benefit from accepting responsibility for his or her situation?

On this track, we discussed the various triggers of defensive anger in BPD clients. These triggers are  criticism; fear of unworthiness; and helplessness.

On the next track, we will examine active response choices for BPD clients. These response choices include  expressing a specific need; negotiating; and ultimatums.

Peer-Reviewed Journal Article References:
Peters, J. R., & Geiger, P. J. (2016). Borderline personality disorder and self-conscious affect: Too much shame but not enough guilt? Personality Disorders: Theory, Research, and Treatment, 7(3), 303–308.

Scott, L. N., Stepp, S. D., Hallquist, M. N., Whalen, D. J., Wright, A. G. C., & Pilkonis, P. A. (2015). Daily shame and hostile irritability in adolescent girls with borderline personality disorder symptoms. Personality Disorders: Theory, Research, and Treatment, 6(1), 53–63.

Scott, L. N., Wright, A. G. C., Beeney, J. E., Lazarus, S. A., Pilkonis, P. A., & Stepp, S. D. (2017). Borderline personality disorder symptoms and aggression: A within-person process model. Journal of Abnormal Psychology, 126(4), 429–440. 

What are three triggers of defensive anger? To select and enter your answer go to Test.

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