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Mental Disorders

by Kimberlee Roth and Freda B. Friedman
New Harbinger, 2003
Review by Nancy Nyquist Potter, Ph.D. on Aug 12th 2004

Surviving a Borderline ParentPeople diagnosed with Borderline Personality Disorder have a reputation for being extremely difficult, impulsive, explosive, and angry people. It makes sense that growing up with a parent who exhibits symptoms of BPD would also be difficult. This book explains how BPD is experienced from the child's point of view, discusses short- and long-term effects on the developing child and adult, and sets out ways to heal from a chaotic, confusing, and frightening childhood.

As a general self-help book, it has some redeeming qualities. The purpose of this book, according to the authors, is to help readers "identify patterns that affect your life today" (p. 27). To this end, the book has sections called "Stop and Think" and numerous exercises that can be useful to readers. For example, one exercise asks readers to think about characteristics they had as a child that helped them build resilience. The authors say, "If what you read resonates with your experience, and the exercises get you thinking about new ways to handle vexing belief systems and behaviors, we think you'll benefit, regardless of a formal diagnosis (or lack of one)" (p. 6). This claim is especially relevant to the second half of the book, which offers some practical suggestions for change that apply fairly generally to problems in living.

But it is the very generality that is its weakness and, in fact, presents a serious problem. A significant percentage of the population in the Western world has been diagnosed with Borderline Personality Disorder (BPD). Ten percent of the patients seen in outpatient mental health facilities and twenty percent of those seen as psychiatric inpatients are diagnosed with BPD.[1] John Gunderson reports that "[I]t is easily the most widely and commonly used diagnosis for personality disorders in modern clinical practice"[2]. So widespread is this diagnosis that Theodore Millon has characterized Borderline Personality Disorder as an epidemic.[3] (An epidemic, according to the Center for Disease Control, is the widespread occurrence of more cases in a place and time than expected.) Medical epidemics are quantitatively measured but, as we know, when a new illness proliferates, the public can start seeing symptoms inaccurately. For this reason, it is crucial that authors who want to discuss a widespread mental illness be very careful to be precise about their subject. Readers must be reigned in from a tendency to diagnose others.

In the preface, the authors do warn readers that diagnosis should be left to professionals. However, they proceed to present a list of thirty-two characteristics for readers to ask themselves "Does this found familiar," after which they declare "If you relate to many of these experiences, chances are you may been raised by a parent with BPD or BPD-like traits" (p. 3). Chapter One is entitled "I Never Knew It Had a Name." The authors discuss each criterion, give examples, and set out what they call "take-aways"--the messages that children receive as a result of behavior associated with that criterion.

The problem with this chapter and the rest is that much of what the authors claim about BPD parents is not unique to them—in other words, their remarks are so general that far too many readers could conclude that they were raised by a BPD parent. They say, "Parents with BPD may not accept responsibility for their behavior" (p. 19), but this is true for a number of parents. Likewise, when they give a list of "lessons" children may learn, most items on the list can be found in any dysfunctional family. For example, "It's unsafe to express your true feelings," "You can't trust yourself, since your perceptions are usually corrected," and "People manipulate; gifts come with strings attached," are rules learned in many, many families. Parents, whether mentally ill or not, can be narcissistic, demanding, insensitive, critical, and quite sure they are right.

Claims are overly general in other ways as well. In a chapter on guilt, the authors write that "People with emotional challenges may induce feelings of guilt in others through their attempts to control their own environment and minimize unknowns, illicit a desired result from others or a desired outcome to a situation, or avoid taking responsibility for their actions, accepting their own feelings, or facing their own thoughts" (p. 69). This is also true of drug addicts. Internalized but irrational guilt, which the authors say is "common for adult children of a parent with BPD," is common for thousands of others as well, most of whom are not mentally ill. A readiness to blame others or think ill of them is true for alcoholics as well as BPD parents. Chaos in families can be caused by several different things, not only having a BPD parent. Projection, to some extent, is just a human problem, as it is a primary defense mechanism that people sometimes revert to. The authors never acknowledge any of the ways their statements apply to other conditions, which gives readers room to make inferential leaps about BPD in their own family that may be unwarranted.

Even though Surviving a Borderline Parent is a self-help book and not an academic treatise, it could have used some rigor.  "Revealing the Truth" suggests that the reader "write a letter to your parent telling your truth" and to "write your truth" (p. 51; emphasis added). Is truth subjective then? It certainly sounds like it here—but if that's the case, how can an argument be persuasively made that BPD parents have done so much wrong? Aren't they living "their" truths as well? This theme comes up again in a chapter on "Grieving a Lost Childhood," where authors discuss "Telling Your Truth to Family and Friends." Readers would have benefited from an explanation of what "your truth" means in the context of experiences like abuse or neglect. Are there no facts of the matter about what happens in families? 

A section on forgiveness is not very nuanced or sensitive to the wide range of moral wrongs possible for people to commit. The authors say "forgiveness does not entail expressions of remorse, regret, or contrition on the part of the person who hurt you." This rather astounding statement goes against a significant body of literature on forgiveness that grapples with these questions rather than merely asserting that remorse is irrelevant to forgiveness.[4]

Another concept left unexplained is central to this book, and that is the concept of trust. If self-trust is such an important tool for healing, it deserves at least a definition. The authors suggest that the way to learn to trust oneself is to "follow your feelings," which amounts to saying that you learn to trust yourself by trusting yourself. Furthermore, if one's childhood was really as awful as the authors are trying to portray, it doesn't seem like one's intuition would be a very firm foundation on which to rely. The authors do suggest that readers also check things out with their friends, but doing so will require that readers know what being trustworthy is and how to identify trustworthy others. No discussion of this thorny problem is offered.

Good books exist that discuss how loved ones can cope with a mentally ill person. An example of a family support book for a mental illness that is successful, helpful, and specific to the illness is Mondimore's book on bipolar disorder.[5] Others who want to write in this genre should draw on a model like his. As I say, there is helpful information in Surviving a Borderline Parent, but it is misleading in so many ways that its usefulness is undermined. I fear it will contribute to the already-much-maligned patients who are diagnosed with BPD and will foster armchair diagnosing that undeservedly constructs others as personality-disordered.

© 2004 Nancy Nyquist Potter

Nancy Nyquist Potter is the author of How Can I Be Trusted? A Virtue Theory of Trustworthiness (Rowman-Littlefield Press 2002) and is currently writing a book on a philosophical analysis of Borderline Personality Disorder, to be published by Oxford University Press.



[1] American Psychiatric Association. 2000. Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Text Revision. Washington D.C.: American Psychiatric Association.

[2] Gunderson, John. 2001. Borderline Personality Disorder: A Clinical Guide. American Psychiatric Publishing, p. 1.

[3] Millon, Theodore. Sociocultural Conceptions of the Borderline Personality. The Psychiatric Clinics of North America 2002;  Vol 23(1): 123-136.

[4] Cf. Before Forgiving: Cautionary Views of Forgiveness in Psychotherapy. Ed. Sharon Lamb and Jeffrie Murphy. Oxford: Oxford University Press, 2002.

[5] Mondimore, F., M.D. 1999. Bipolar disorder: A guide for patients and families. Baltimore and London: Johns Hopkins Press.


Randi Kreger sent the following response to Nancy Nyquist Potter's review on December 30, 2008. It was published on January 8, 2009.

I am writing in regards to Nancy Nyquist Potter's review of Surviving a Borderline Parent by Kimberlee Roth and Freda B. Friedman, Ph.D., LCSW.  I wrote the foreword to the book. I am also the author or coauthor of three other books about borderline personality disorder: The Essential Family Guide to Borderline Personality Disorder (Hazelden Publishing, 2008), The Stop Walking on Eggshells Workbook (New Harbinger, 2002), and Stop Walking on Eggshells (New Harbinger, 1998).

Potter's primary objection to the book, which she believes in minimally helpful and even harmful, is that readers will falsely conclude they were raised by a borderline parent because what much of what the authors claim about BPD parents is not unique to them.

For example, the authors point out that people with BPD may not accept responsibility for their behavior without pointing out that people with other diagnoses may do that too. Or, the authors say that people with BPD use projection without mentioning that people with other diagnoses do this as well.  This will lead, she says, to "armchair diagnosing."

However, the authors (one of whom is a clinician trained in Marsha M. Linehan's Dialectical Behavior Therapy) examine the DSM-IV very carefully for eight pages using a variety of examples and take away points. The authors also explain that five of the nine criteria must be present to make a diagnosis. In addition, as Ms. Potter points out, the authors have a disclaimer, warning that a diagnosis should be made by a professional. Given these two elements, there is little chance that readers will be mislead.

In fact, most of the nine traits that are characteristic of BPD can also apply to other disorders, including rages, identity disturbance. suicidal ideation, cutting, impulsivity,  dissociation, and disturbed relationships.

What is most ironic is that foremost problem facing people with BPD and their family members is that the vast majority of clinicians have no recent training in BPD and are unable to make a correct diagnosis or provide the appropriate treatment.

Surviving a Borderline Parent is one of only two books currently available just for people with a borderline parent. It has been used without any confusion by hundreds of adult children in my own Welcome to Oz online support community. Let's put it back on the bookshelf where it belongs.

Randi Kreger

Randi@BPDCentral.com

www.BPDCentral.com