14 October 2013

Idealization and devaluation

Every field has its proud jargon and psychology is no different.  I've gotten so used to certain terms that I don't even correct people any more.  I mean,  when someone claims, "I'm completely antisocial," I'm quite certain she doesn't mean that she is a psychopath or a sociopath, but that she prefers solitude over social engagement.

I've also found that when folks describe themselves or others as bipolar, it is not in reference to alternating manic and depressive episodes, but to either benign fluctuations of thoughts and feelings or to the much more malignant cycle of idealization and devaluation as seen in Borderline Personality Disorder (BPD).

The DSM-V (Yes, my full time stay-at-home status somehow necessitated my purchasing this expensive guide to quell my growing sense of professional obsolescence.) doesn't deviate from its predecessor in describing BPD as a pervasive pattern of unstable self-image, interpersonal relationships, and affects.

The aforementioned idealization and devaluation can been seen as happening on three levels: within the self, within the dyad, and within the group.  Self idealization may take the form of impulsivity in excessive spending or reckless driving reminiscent of manic episodes.  Then instability of self structures means the onset of dysphoria punctuated by rage or panic.  The patient who presents with BPD is easy to spot.  She doesn't bother to build a working alliance but instead quickly reveals intimate details, professing the clinician's therapeutic prowess.  And then, just as suddenly, a real or, more often, an imagined, abandonment by the clinician turns him into a cruel, rejecting monster and thusly the object of the patient's extreme anger.  This is the patient who falsely reports you to the Board for sexual misconduct and who terrorizes your online presence with scathing reviews.  Either way, the prospect of a session with her incites you to defensive actions or simply drains you of breath.  Because, folks, countertransference is the name of the game!

Finding the BPD patient among a group may be a little trickier because she instigates the chaos, but from a hidden sheltered position that (initially) conceals her.  In a group, the individual with BPD finds a sympathetic ear and turns this person into the target of idealization.  This is particularly easy for targets who already have narcissistic traits, which, let's face it, is often the case among clinicians.  Now armed with an idealized supporter, the BPD patient then goes on the attack against the party or parties who were seen as neglectful or abandoning.  On inpatient wards, small preexisting rifts among staff members are ripped wide open by defensive BPD patients who, at first, escape blame because the feud appears as though it only involves two disparate factions among the staff.  So the next time it seems as if there is infighting amongst previously peaceful staff members, question whether is a frantic BPD instigator right in the middle of it!

On a much lighter note, here are the boys on a hike:


Michelle said...

Somehow, that description of a BPD patient in a group setting also accurately describes the fallout a moms group I was once a part of.... There's always that One. :P

Lam said...

Yuck! So sorry that happened to you!

As you can imagine, the impetus for this post came from a recent real-life experience...bizarre infighting amongst longtime allies and the chaos turned out to have originated from a single, highly disordered source. Bleh.

Michelle said...

Luckily, I'm always on the sidelines, chronicler of the chaos (and member of the peanut gallery) rather than a participant. Nonetheless, it was pretty ugly and reminded me why I liken motherhood to high school!

Lam said...

Lol. I think the high school analogy is far better than being compared to a psychiatric inpatient ward. ;)