“I’m such a loser.”

“I can’t do anything right.”

“I’m ugly.”

Too often, people brutally judge and attack themselves. If everyone treated others as poorly as they treat themselves, the old biblical adage, “Love your neighbor as yourself,” could be a recipe for war.

Negative Beliefs, Self-Loathing, and Why It Matters

Incessant negative beliefs about oneself may be called self-loathing, self-judgment, self-attack, or low self-esteem, but it all boils down to one menacing problem: self-hatred. At its most extreme, self-hatred can lead people to retreat into substance use, suicidal and other self-destructive behaviors, or violence toward others.

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If you beat up on yourself, are disgusted with yourself, or in any other way experience the effects of self-hatred, there are two important things to know: why the self-hatred exists, and what you can do about it.

Why Self-Hatred?

Self-hatred almost always stems from childhood. Trauma experienced after childhood also can fuel negative feelings about oneself.

Children believe what they hear from others. If a parent tells a child that she is good for nothing or can’t do anything right, then that becomes the truth in the child’s mind. It takes a very mature and insightful child to say to herself, “Something is wrong with Mom/Dad for telling me this. An adult shouldn’t say such mean things to me. I’m just a child.”

Instead of saying, “Something is wrong with Mom/Dad,” the child usually thinks, “Something is wrong with me.” That simply is how a child’s mind works. Children need safety and stability. It is much less chaotic for a child to think something is wrong with himself than to think he cannot rely on the people upon whom he depends for food, shelter, and survival.

Sometimes, a child never hears harsh judgment from a parent or other caregiver, yet self-hatred manages to fester. This happens when, for whatever reason (genetics, environment, plain bad luck, etc.), a child experiences anxiety, perfectionism, or other traits that conjure feelings of self-blame in the face of fear, imperfection, or other perceived flaws.

Trauma, too, can inspire self-hatred. It can feel safer to attack oneself over what happened than to accept that bad things happen randomly in the world—and can happen again, at any time. As a result, many people who have endured sexual assault, combat, or other trauma blame themselves for what they endured, and self-hatred grows.

Self-hatred and shame are related but not synonymous. Shame can be healthy, the mind’s tool for helping people understand when they have done something that must not be repeated. However, the majority of shame that people experience is not a healthy tool for learning right from wrong. Instead, it is a manifestation of self-hatred, a message that when they do things wrong (or, at least, differently than they wish they had) then they are wrong, a judgment of the person and not the act.

Many people who feel shame cannot assign it to any particular action. Shame is a feeling of essential badness that they simply cannot shed. Often, people experiencing unhealthy shame feel that if others saw their real self, then nobody could possibly love them.

It is helpful to understand how your own self-hatred is formed. This can help you to develop compassion for yourself. No matter what you did or did not do as a child, no matter what trauma you endured, the hurt part of you deserves love, compassion, and nurturing. No matter what, you possess a fundamental goodness that is not touched by external events, in the same way the clouds can cover the sun but never really touch it.

The Antidote: Self-Compassion

A seminal work on self-hatred and self-compassion is titled, appropriately enough, Compassion and Self Hate (by Theodore Isaac Rubin). More recently, mental health professionals have published quite a few more books on self-compassion, including The Mindful Path to Self-Compassion (by Christopher Germer), Self-Compassion: Stop Beating Yourself Up and Leave Insecurity Behind (by Kristin Neff), and The Power of Self-Compassion (by Mary Wellford).

There are websites devoted to self-compassion. There also is an evidence-based psychotherapy that cultivates self-compassion. Called compassion-focused therapy, it extends cognitive behavioral concepts to foster in people the ability to soothe, accept, and understand themselves.

The common theme underlying all these works is that self-compassion is the antidote to self-hate. So how do you create more compassion for yourself? Over time, I will write about many different ways to grow the seeds of self-compassion. For now, here are a few tips to get you started:

• Talk to yourself the way you talk to someone you care about: In Compassion and Self Hate, Dr. Rubin advises readers to tell themselves, “I treat myself as I treat a child I love.” Cognitive behavioral therapists employ a similar technique, often invoking the question, “What would you say to a good friend who was going through the same thing you are going through?” These are important questions. If you hate yourself, you likely say things to yourself that you would not dare say to another person. What would you say to somebody else who has the exact same traits as you? What could you say to yourself?
• Recognize that beliefs do not equal truths: Often, people believe what they tell themselves. If you think you are a loser, you may believe it is absolute truth. Try this cognitive behavioral technique called “the three C’s”: catch, check, change. Catch yourself thinking something negative about yourself. Check whether your distressing thought is true. Change it, if not. You can talk back to your negative thoughts. Challenge them. Serve as a defense attorney to the prosecutor in your head.
• Embrace the concept of “good enough”: Many people feel they should be perfect—never angry, always generous, never critical, always right, and so on. These expectations deny that imperfection is the human condition. If you are one of these people with too-high expectations for yourself, ask yourself what is good enough?
• Consider turning to spirituality or religion: Many spiritual or religious traditions center on the belief that people are flawed but inherently good, not only lovable but also inherently loved. These beliefs can serve as a huge balm for the hurting soul. The practices of meditation and mindfulness, too, can foster feelings of self-compassion as well as loving kindness toward others.
• If you hate yourself for mistakes you made, make amends: You may be reading this and thinking, “This does not apply to me. I did something so awful that I can never be forgiven.” First, as much as you condemn yourself, ask if you would equally condemn—to their face—someone else who did the same thing. If not, then you are being unfair to yourself. Perhaps you really did do something awful. If you cannot make amends to the person or people you harmed, do something good for somebody else. Beating up on yourself serves nobody. Doing good for others or taking part in a larger movement not only helps others, it helps you—and it can lead to self-forgiveness.
• Try therapy: A good, compassionate therapist can help you foster self-compassion and better understand the roots of your self-loathing.

My Questions for You

Do you ever hate yourself? If so, what helps you to deal with this brutal judge who lives inside your head? What tips do you have for others in the same situation?

The diagnosis of “borderline personality disorder” carries profound stigma for many people. Even some mental health professionals use the term pejoratively, which is not difficult considering that the diagnosis itself implies that someone’s personality is flawed. In reality, the flaw lies within the diagnosis—not to mention all the painful and agitating symptoms that come with it.

I will go into more depth about these challenges, but first a definition is in order.

What Is ‘Borderline Personality Disorder’?

People who are diagnosed with borderline personality tend to have problems with unstable self-image, moods, and relationships. They may experience suicidal thoughts, self-harming behaviors, displays of anger or irritability, and periods of intense sadness or despair called “dysphoria” (the opposite of euphoria).

To receive a diagnosis of borderline personality, a person must meet at least five of the nine characteristics below. Keep in mind while reading the list that, in order to qualify for the diagnosis, the person’s symptoms must be longstanding and inflexible, not just occasional ways of relating to life:

1. “Frantic” attempts to avoid abandonment
2. Intense and turbulent relationships, with a tendency to alternate between seeing the other person as all good or all bad
3. Unstable sense of self, which could lead to radical changes in major aspects of identity such as career, religion, or sexual orientation
4. Frequent suicidal thoughts or self-harming behaviors, such as cutting
5. Impulsive behaviors in at least two other areas, such as substance abuse or binge eating
6. Wild mood swings with extremes of anxiety, irritability, or dysphoria
7. Persistent feelings of emptiness
8. Intense anger or rage that is often close to the surface
9. Brief periods of paranoia or dissociation when under stress

I have seen more than one writer refer to borderline personality as the equivalent of emotional hemophilia: when a person with borderline personality experiences a hurt, even a small one, the emotional bleeding is profuse. The suicide rate for people with borderline personality is about 10%. Most people—up to 90%, by some estimates—with borderline experienced neglect or abuse, particularly sexual abuse, during childhood. Individuals with borderline personality commonly view themselves as inherently defective, bad, or broken.

For many years, borderline personality disorder was considered untreatable. Now, decades of research and treatments have illuminated the errors in such thinking. For one thing, we know that many people “grow out” of the disorder as they age. For another, a great many people with the diagnosis respond positively to treatments such as dialectical behavior therapy.

Stigma and Borderline Personality

All personality disorder diagnoses are controversial. The mere phrase “personality disorder” situates the problem in the person’s personality, rather than neurology or life stressors (including trauma). GoodTherapy.org’s founder, Noah Rubinstein, LMFT, has even explained why he views personality disorder diagnoses to be flawed:

“I believe that by labeling a person as personality disordered or, in its more gentle form, stating that a person has a personality disorder, we are essentially claiming one’s personality, their person-hood, their essence, is fundamentally flawed. What else are we, other than our personality? Such a diagnosis is very, if not absolutely, likely to produce more shame, worthlessness, and rejection in a person who probably has enough of it already.”

I agree with his analysis. In some ways, the situation is even worse for people diagnosed with borderline personality. Any mental health diagnosis can engender feelings of shame, or of being “fundamentally flawed.” On top of that, feelings of shame and badness are both symptoms and consequences of borderline personality. This can create a vicious cycle, as if the diagnostic label alone confirms the feelings of defectiveness that came well before the diagnosis.

Too often, some mental health professionals add to the stigma. It is well known that some clinicians have applied the label “borderline” merely because they do not see an individual improving, or the individual poses challenges such as expressing overt anger toward the therapist. For some therapists, it is easier to blame the client for treatment’s lack of success than it is to look at the clinician’s own inability to help.

Another source of stigma concerns others’ tendencies to judge the person, rather than the person’s behaviors. Some, though certainly not all, people with borderline personality may cope or express their pain in ways that hurt those around them. They may yell or even be physically violent, make unrealistic demands, display intense sadness or anger at what seems a disproportionately small provocation, or even attempt suicide or hurt themselves in ways that make another person feel manipulated.

It helps to keep in mind the fundamental, excruciating pain that often underlies borderline personality disorder. Marsha Linehan, the psychologist who created dialectical behavior therapy, compares the behaviors of people with borderline personality disorder to those of people with painful cancer who will do anything to reduce their pain. The cancer patients may cry, scream, or attempt to “manipulate” others in order to get their pain medication. But we seldom view their efforts negatively, because we understand their abject suffering. Their behaviors make sense.

So, Should the Diagnosis Be Abolished?

I agree with other critics that the label “borderline personality disorder” can compound an already painful situation for people, especially the newly diagnosed. But I also find value in the diagnosis—not the name, but the concept.

Before diagnosis, people with borderline personality often feel bewildered. They may deeply experience their internal chaos yet find that few people understand. I have worked clinically with many people who felt soothed when they learned their problems fell into a distinct category that millions of other people shared. These people felt they were no longer alone.

Once people have a name for a condition, they can more easily find information about challenges and ways to heal. They can find other likeminded people in online support groups. Also, diagnoses enable clinicians to better treat people. Clinicians can draw from a large body of research on borderline personality to identify the best treatment options for individual clients.

The diagnostic label deserves to be changed, but the construct itself should remain, as long as it is supported by continued research. Some researchers, like the psychologist Judith Herman, think that borderline personality actually is a type of posttraumatic stress, and should be reclassified as such. But the idea has not gained much momentum in the field of psychiatric diagnosis.

Changing the name, too, is a pipe dream for now. The American Psychiatric Association only months ago released its first overhaul in almost 20 years of the Diagnostic and Statistical Manual of Mental Disorders, and the group never seriously considered altering the name. That is a shame. The name of a diagnosis should describe the problem—in this case, problems regulating emotions—not the personality. Others have proposed alternate names. My preferred label is one proposed by Dr. Linehan, “Emotion Dysregulation Disorder.”

What Can We Do to Diminish the Stigma?

Use the word “borderline” appropriately. Do not use the word “borderline” as an insult. This especially applies to mental health professionals. I have worked in the mental health field for almost 20 years, and it is disheartening how many times I have heard a professional say “She is so borderline,” or “What a borderline.” Borderline is an adjective to describe a series of symptoms, not a person. And it certainly is not a noun.

Be clear that stigma is undeserved. When we discuss how stigmatizing the diagnosis of borderline personality can be, it is necessary to make clear that the stigma is unfounded. Despite appearances or assumptions, the label does not truly mean that somebody’s personality is flawed. We need not buy into the pejorative meaning.

Exercise compassion. Whether you know somebody with borderline personality or have the symptoms yourself, always keep in mind the underlying pain and anger that can drive behaviors. This is not to say that people with borderline personality are not responsible for their behaviors and cannot make changes. Rather, a compassionate stance helps diminish shame. It also emphasizes the possibility that people can learn more constructive ways to manage their emotions.

Avoid stereotypes. The diagnosis of borderline personality captures a very heterogeneous group. Only five of the nine diagnostic criteria are required for a diagnosis. Two people with the diagnosis could have only one symptom in common. In fact, there are 256 different possible symptom combinations for borderline issues, and every person who has been diagnosed with borderline personality has his or her own unique stories.

Maintain hope. As I noted above, borderline personality need not be a lifelong struggle. The symptoms of borderline personality often mellow with age. Borderline personality disorder, as a diagnosis, also has the advantage of garnering significant attention among researchers, clinicians, and grant funders. New discoveries continue to be made.

More and more, we learn about effective ways to treat people who are diagnosed with borderline personality. These gains in knowledge lead to more hope: hope for people to heal, and hope for the condition, by whatever name, to elicit less stigma and more understanding.

References:

1. American Psychiatric Association. (2013). The diagnostic and statistical manual of mental disorders – 5. Washington, DC: Author.
2. Gunderson, J. G., Stout, R. L., McGlasham, T. H., Shea, T., Morey, L., Grilo, C. M., Zanarini, M. C. et al. (2011). Ten-year course of borderline personality disorder: Psychopathology and function from the Collaborative Longitudinal Personality Disorders Study. Archives of General Psychiatry, 68, 827 – 837.
3. Leichsenring, F., Leibling, E., Kruse, J., New, A. S., & Leweke, F. (2011). Borderline personality disorder. The Lancet, 9759, 1 – 7.
4. Lilienfeld, S. O., & Arkowitz, H. (2012). Diagnosis of borderline personality disorder is often flawed. Scientific American. http://www.scientificamerican.com/article.cfm?id=the-truth-about-borderline
5. Linehan, M. M. (1993). Cognitive behavioral treatment for borderline personality disorder. New York: Guilford.