Treatment For Borderline Personality Disorder
Borderline Personality Disorder: Symptoms, Treatments, Facts
Borderline personality disorder (BPD) is a mental illness that is characterized by an inability to manage or regulate one’s emotions or feelings. It’s about lacking the ability to put feelings and emotions into the appropriate “boxes”, and this can lead to self-destructive and impulsive behavior caused through the inability to recognize boundaries. Sounds complicated? That’s why you’re reading this! We’re here to make it easier for you!
One sad aspect of borderline personality disorder is that the condition often goes completely untreated for years—or forever in many cases—or, if put in front of a mental health expert, is actually misdiagnosed. Oftentimes someone suffering from BPD is diagnosed with bipolar disorder or some other condition such as PTSD, depression, or ADHD instead.
Borderline personality disorder was only first recognized as a real condition by mental health experts in 1980, when it was included for the first time by the American Psychological Association (APA) in the third addition of its Diagnostic and Statistical Manual (DSM III). It might be because it was so recently recognized that BPD, compared to other psychiatric problems, receives rather less attention in terms of funding and research. Indeed, according to PubMed.gov, an online source affiliated with the US National Library of Medicines, BPD receives less than one tenth of the funding from the National Institutes of Health as does bipolar disorder.
Stigma and fear is, unfortunately, something all too common when thinking about any form of mental disease. When a person is diagnosed with borderline personality disorder, it can cut straight through to their soul. To be told that your personality is somehow disordered or not working, can be incredibly demeaning and damaging to someone who is already vulnerable.
Many mental health experts are now actually starting to refer to borderline personality disorder by the kinder sounding name of “emotion dysregulation” or “emotion regulation disorder”, which might well be a better term and maybe help people get to grips with the condition in an easier way.
However the disorder is named, there is hope for sufferers of BPD and their loved ones. According to the ABA, treatment for borderline personality disorder is generally very effective with correct diagnosis and the right types of therapy, which will be discussed later in this article. It has also been seen that BPD symptoms can sometimes dissipate even without treatment, as the sufferer of the disorder ages and becomes more efficient at managing their emotions or their reactions to situations. Another school of thought as to why BPD can diminish with age is the theory put forward by some experts that the symptoms just naturally “burn” out. Impulsive behavior decreases as one gets older, and people just get mellower. The condition might still be there – in fact, without treatment, it more than likely is – it’s just that age and experience helps people to control it a lot more than when they were younger.
The bottom line is that borderline personality disorder needn’t be something to truly fear, and can always be helped with the right diagnosis and treatment.
Causes and Symptoms of Borderline Personality Disorder
As with the majority of psychological conditions, scientists and mental health pros are, quite frankly, still pretty much up in the air about exactly what the causes are of borderline personality disorder. There are more than likely to be various root causes of the disorder, with different schools of thought differing on the main cause. There is one school of thought that puts it primarily down to genetics (BPD running in the family), another school of thought that puts it down to environmental factors (childhood trauma or abuse, for example), and yet another blaming biology (abnormalities or lack of proper functioning in the parts of the brain that influence a person’s emotions or their behavior).
The true cause of borderline personality disorder is more than likely—as is most often the case with mental illness in general—a mixture between the three schools of thought. Again, the fact that BPD is so often completely overlooked makes the exact causes of the condition so much harder to pin down. Probably the most prominent cause, and the easiest one to link to the condition right now in these relatively early days of research, is the environmental one. Most sufferers of the condition have undergone some sort of trauma earlier on in their lives, more often than not as children. Some of the sorts of traumas that can cause BPD in later life are listed below:
- Being lost as a kid (really lost, as in your parents mislaid you in the supermarket)
- Instability in the home while growing up (parents’ divorce, domestic violence— either as a witness to or victim of, drug taking, alcoholism, constant arguments going on… general stress at home in general to the point where one doesn’t feel like home is one’s “safe place” so-to-speak)
- Being bullied at school
- Being neglected by family or friends
- Being sexually abused as a child or even hearing or knowing about other sexually abused people.
The above factors are just general theories as to what could be a cause of BPD, but really anything that sets a person off-kilter in childhood could contribute to the condition in later life; anything that causes a negative emotional reaction or leads to feelings of being abandoned or damaged in any way.
Of course, not everyone who has experienced trauma as children grows up to have a borderline personality disorder, which is the main reason why there are obviously other causes in play too, such as the biological or genetic ones mentioned above.
A rudimentary search online will show that there are many different tests that one can do—simple tests that ask a few yes-or-no or multiple-choice questions—in order to determine how likely you are to have a borderline personality disorder. These tests are not designed to officially diagnose—only a mental health professional can do that—but rather to give you a rough idea of whether you might be suffering from BPD
or not. These tests outline well some of the most prevalent symptoms of the disorder and they all generally seem to have the following questions or themes in common:
- BPD tests ask about feeling empty—or “dead inside” much of the time. The more feelings of emptiness that one has, the more chance they may have the disorder.
- A pattern of reckless, impulsive, damaging behavior. Any BPD test will ask about this. If someone admits to regularly indulging in two or more of these activities, it’s a good sign of having the disorder. These behaviors include reckless driving; promiscuity or inappropriate/unsafe sex; binge eating; abuse of drugs or alcohol; wild gambling; reckless spending of money. Any kind of behavior, really, that causes one to push the “self-destruct button” knowingly and on a regular basis.
- Feelings of paranoia after being abandoned, or after perceiving that one has been abandoned. Abandonment issues are a main feature in any test to determine BPD, and someone with the condition will often go to any lengths to avoid being abandoned by someone. The BPD sufferer will take any “abandonment”—such as being left by a partner, losing a job, being broken friends with—extremely badly and work hard to avoid that possibility, even if the abandonment is actually imagined. Often, some sort of abandonment—real or accidental—in the past is a root cause of the condition in the first place. A staple question in a BPD test is whether when feeling abandoned by someone, one often “shuts down” or “spaces out” in order to try to avoid the intense feelings of grief or pain that the abandonment brings. Again, abandonment issues are key in any BPD diagnosis.
- A BPD test poses questions about relationships and interaction with other people. Does one often go “all in” when meeting someone for the first time, often to an inappropriate degree? An example of this is telling acquaintances about some of the most personal issues in one’s life, being too open with people about things, people who the BPD sufferer might not really know that well, thus perhaps causing awkwardness for the other person. People suffering from a BPD often seem to have these “boundary” issues and of course when the other person withdraws a little, feeling uncomfortable, that goes back to the abandonment issues mentioned previously.
- Another question regarding relations with others that is posed in most BPD tests is this: Do you swing between extreme emotions when it comes to other people? Do you switch from feelings of love to hatred, from over idealizing to under appreciating or undervaluing people on a dime? Is it always drama with other people, always one extreme or the other? If so, this is a typical symptom of borderline personality disorder.
- Do you experience feelings of anger on a regular basis? Do others see you as sarcastic or bitter? Do you find it hard to reign in your feelings of anger, often for no reason at all? This is a question that appears on most of the online self-assessment tests for BPD. The purpose is to try to determine how much control one has over his or her own emotions at any given time. The more often that someone feels angry, the more chance they have of having some form of BPD.
- Self-harm, either now or in the past. Have you ever had suicidal thoughts, attempted suicide, threatened to others that you would kill yourself? Have you ever cut yourself, burnt yourself, or threatened to hurt yourself in any way? Oftentimes these threats come when under pressure from abandonment: “If you leave me I’ll kill myself I swear it!” Threatening to others about carrying out an act of self-harm or attempting suicide is no different from actually carrying it out when it comes to seeking a diagnosis of borderline personality disorder.
- Another question pertaining to paranoia—paranoia is a key component of borderline personality disorder—is this: Do you often feel that other people are actively plotting against you? Do you get suspicious of a lot of people, thinking that they are out against you? Again, the more often or the more intensely that you have these feelings, the more chance there is of a positive BPD diagnosis.
- Mood swings. Although the BPD sufferer will go through vast swathes of his or her life feeling empty inside, when they are not empty, they are at extremes. Either wildly, euphorically, happy, or intensely unhappy or angry or irritable. Nothing is ever “normal”—it’s either one extreme or the other, or nothing at all. This comes down to the inability to manage one’s own emotions in a regular and balanced way.
The above symptoms are all laid out in any online test that one might take to determine whether they may have borderline personality disorder or not. However, it’s important to note here that an online test, conducted by yourself over the internet at home, is NOT conclusive proof that you have a BPD. These tests are seen as just a guide only, nothing more, with the aim of giving you a rough idea on whether you may be suffering from this or not. There are other conditions, outside of BDP, that may see some of the same symptoms, which makes the disorder so hard to really pin down. The advice here is to really go and see a professional if you think that you might be affected by BPD, don’t just trust an online test. The professional will ask much of the same questions that you find in the test, but will also be able to determine what help you need as well.
Prevalence of Borderline Personality Disorder
So who actually gets BPD? How common is it among people? It’s tough to answer given that so many people never seek treatment for the disorder, and because it’s still such an easy condition to misdiagnose. However, with that said, it’s estimated that almost six percent (5.9) of adults are affected with the disorder at some point during their life. In the United States, that counts as around 18 million people.
A 2008 report on borderline personality disorder, conducted by the Substance Abuse and Mental Health Services Administration (SAMHSA)—part of the US Department of Health and Human Services—in response to a House of
Representatives request, found that contrary to earlier studies that had concluded that BPD was as much as three times prevalent in women than in men, the reality was much more balanced, with 5.6 percent of men estimated to be affected and 6.2 percent of women.
The SAMHSA reported that “BPD is much more prevalent in the general population than previously recognized; is equally prevalent among men and women, and is associated with considerable mental and physical disability, especially among women.”
So what the report was saying was that although men suffer from BPD at almost the same rate as women, it seems to affect women in a much more severe way. This might go some way as to why previous studies simply thought that much more women had the illness in the first place. In actual fact, it appears that men just hide their BPD better, not that they don’t have it and don’t need help.
Men and women combined, the prevalence percentage of borderline personality disorder is 5.9 percent, which as we saw—according to the 2008 SAMHSA report—is much higher than previously thought. To give that figure some comparison, the lifetime prevalence of schizophrenia is around 0.4 percent and bipolar disorder is at 1.4 percent. The prevalence of BPD is more than three times that of bipolar disorder. As mentioned earlier, many people who actually have BPD are diagnosed instead as being bipolar.
Some other interesting stats about the prevalence of borderline personality disorder in the United States and who is more likely to be affected are as follows:
- BPD has a higher prevalence among Native American men than among the rest of the population
- BDP prevalence is lowest among Latinos (both men and women) and among Asian women
- Younger adults who are separated, widowed, or divorced have a higher prevalence of BDP than the general population
- Non-college educated people are more likely to be affected by BPD than those who have a more formal education
- BPD affects more people in lower socioeconomic conditions than in more affluent conditions.
The pattern here seems to be that those who have suffered more in life, experienced more stress and more trauma, are more susceptible to developing BPD than those for whom life has been much more of a smooth ride. To this end, the following facts about BPD also play out:
- In the US prison system, 17 percent of inmates have been diagnosed with BPD. That’s compared with the 5.9 percent of the overall population. In fact, people displaying various symptoms of BPD tend to find themselves in the criminal justice system more than people who don’t, both as perpetrators of crime and as victims.
- Hospital inpatients seem to display a higher prevalence of BPD than outpatients, with both groups displaying a much higher prevalence than the general population. The SAMHSA report estimated that around 10 percent of outpatients display signs of BPD and around 15 to 20 percent of inpatients. Again, going back to that trauma and stress factor?
- BPD is seen in 20 percent of people admitted to psychiatric hospitals in the United States.
- Among victims of suicide, it’s estimated that 10 percent of adults and 33 percent of young people have BPD. It’s also estimated that somebody who has BPD is 50 times more likely to commit suicide than somebody who doesn’t have the disorder. 70 percent of people with BPD are expected to attempt suicide at least once in their lives.
- Outside of suicide, a massive 60 to 80 percent of people with BPD are likely to practice some form of self-harm (cutting, etc.).
BPD is generally a younger person’s condition, although this sentence should still be viewed with some caution. But with that said, trends seem to show that the condition starts to manifest itself during the late teens and early-20s. It’s possible that it actually manifests itself before that, although mental health experts are extremely cautious about diagnosing anyone under the age of 18 with BPD, simply because many of the symptoms are simply “grown out of”. At the other end of the scale, many sufferers of BPD find that by the time they get into their 40s, they naturally start to experience less of the impulsive behavior that accompanies the condition. It appears that the 20s and the 30s are the “peak years” for the worst symptoms and emotional turmoil caused by BPD.
Types of Borderline Personality Disorder
Borderline Personality Disorder doesn’t just come in one, easy-to-read-the-instructions, package. We know that it’s not easy to identify and that many times it is misdiagnosed. But just to make things even more confusing, there are also different subtypes of BPD, each one a separate entity within the overall condition itself.
In his book, Disorders of Personality: DSM-IV and Beyond – still one of the main go-to references on personality disorders of all kinds – American psychologist Theodore Millon, one of the world’s most renowned experts on personality disorders until his death in 2014, labeled four subtypes of borderline personality disorder that have since become the standard in
determining which kind/s of BPD a patient is suffering from. Million called these subtypes the discouraged borderline, the impulsive borderline, the petulant borderline, and the self-destructive borderline. These subtypes developed out of the most prominent BPD symptoms that Millon’s patients displayed and are outlined in some more detail below.
The Discouraged Borderline.
This is where someone really tends to keep it quiet until they don’t. The discouraged borderline won’t be dominant or pushy at all—he will appear rather meek, in fact, displaying a rather herd-like mentality following the crowd wherever he goes. He tends to be the proverbial “wet blanket”, always there but always seeming sad or dejected in some way. He will be clingy. Underneath that dour exterior though, the discouraged borderline will be seething with rage at the people within the crowd that he follows. He’ll never say anything or express that anger unless pushed to do so, and even then, that expression will more likely come out in harm to himself than to others. Main BPD symptoms include: emptiness inside/boredom, fear of abandonment, boundary/trust issues, deep-seated anger issues, self-harm.
The Impulsive Borderline.
The impulsive borderline is far more vibrant than the discouraged borderline. He is no shrinking violet at all and can be bubbly, flirtatious, and charismatic. He will have an act now think later approach to most things in life and have a tendency to make rash, stupid life decisions that he’ll later regret. Impulsive borderlines are far more likely to find themselves in legal or money troubles than other BPT sufferers and do most of the things they do simply to try to take an edge off that boredom or emptiness that they feel inside for much of the time. Main BPD symptoms include: emptiness inside/boredom, fear of abandonment (for example sleeping with someone they shouldn’t so they won’t leave them), reckless or self-destructive behavior, lack of contact with reality, mood swings.
The Petulant Borderline.
To describe the petulant borderline, it’s best to use Millon’s own words from his book. “Unpredictable, irritable, impatient, complaining, defiant, disgruntled, stubborn, pessimistic and resentful”. The petulant borderline is basically a ticking time-bomb, a volcano waiting to explode. He’s neither a loner nor a sheep—in fact, he doesn’t really know what he is, split between wanting to be with people and wanting them to all go away in order to avoid disappointment. He often drives people away from him anyway, apart from the most patient or those who truly love him, and those who stay around him he often ends up making miserable. Main BPD symptoms include: Suspicion/paranoia, anger, mood swings, lack of contact with reality.
The Self-Destructive Borderline.
He will be the one that hates himself. He’ll do things which he knows are stupid and bad and self-destructive almost as if to sabotage his own happiness or his own wellbeing, like he knows that he’s just a nothing who deserves nothing. He’s in a vicious downward spiral fueled by his complete lack of self-worth or self-value. Unlike the impulsive borderline who does reckless things as part of a way to maybe impress others or make them not leave him, the self-destructive borderline does them simply because he doesn’t care about himself or have any respect for himself. Main BPD symptoms include: emptiness/boredom, reckless behavior, paranoia, relationship problems, lack of knowing who he is.
The four subtypes of borderline personality disorders listed above are rarely so neatly defined in that a person fits entirely into one of the subtypes and has no characteristics of any of the others. In truth it’s a lot more nuanced than that, but as a handy guide for mental health pros, patients, and their families/loved ones, it does give an idea of what to look out for, what to deal with, and what kind of treatment to start with. Pretty much most BPD sufferers will fall into one of the above categories more than the others—it’s rare to see someone split 25 percent equally between all four.
Treatment of Borderline Personality Disorder
So far we’ve just been talking about what BPD is and what it does to people and many would be forgiven for thinking that we’ve painted a pretty bleak picture. But the main thing to remember is that once diagnosed—and often the main issue with BPD is that it’s never diagnosed or it’s misdiagnosed—it’s one of the easier mental health issues to treat. That’s not to say that it’s a walk in the park, of course, and that recovery from BPD isn’t a tough road, but compared to many other mental illnesses the prognosis is generally pretty good.
Catching a diagnosis of BPD in people early is obviously an advantage, even if only to be able to prevent a long life of torment and misery to the sufferer. The problem there is that in many cases with children and teenagers—especially teenagers—what could be identified as BPD could also just be typical obnoxious teenage behavior. As mentioned earlier, this is why experts don’t recommend testing for the disorder on anyone under the age of 18. However, an early as possible diagnosis at 18 years or older is certainly ideal in order to avoid the pitfalls of those peak 20’s and 30’s decades suffering under the yolk of the condition.
Once diagnosed, there are no drugs to treat borderline personality disorder like there are drugs to treat depression, for example (although depression is often an accompanying illness that goes alongside BPD and antidepressants can work to treat that, just not the BPD itself). There are some certain antipsychotic medicines that can help to treat anger, but the reality is that there is nothing as yet out there that can treat that feeling of emptiness and that fear of abandonment that so characterizes BPD and sets it apart from other conditions. Antidepressants, antipsychotics, and various mood stabilizing drugs really help to treat certain side effects of the condition, but not the condition itself. Effective treatment of borderline personality disorder takes some concerted effort and work in the form of psychotherapy.
Once diagnosed, a patient will start one-on-one therapy with a professional counselor or mental health therapist. For many BPD patients, with the trust issues and overall paranoia about abandonment that is part of the condition in the first place, finding a therapist whom they trust is a major issue all on its own. It can be a trial and error process, but once the patient and the therapist have an understanding together, great progress can be made.
Psychotherapy for BPD usually takes two different tacks in order to beat the condition. The first tack concentrates on helping the patient manage their relationships with the people in their lives. It’s called Interpersonal Psychotherapy (IPT) and the aim is to teach the patient how to relate to other people in a positive and effective way and to try to lose some of the fears of abandonment that they might be harboring.
The second tack that therapists take when working with BPD patients is called Dialectical Behavioral Therapy (DBT). This approach is all about relearning how to control emotions better and how to emotionally handle situations that occur throughout daily life. DBT therapy was specifically designed with borderline personality disorder in mind, and the therapist works to offer the patient other ways out of situations rather than the anger or self-harm or threats of suicide that might usually be the norm when facing something while untreated.
DBT therapy, when done right and when completed thoroughly, has proved extremely successful in treating BPD. The patient learns and accepts that there is truly another path outside of the disorder that they can take and they learn to be able to deal with whatever life throws at them. It’s not easy, but most successful treatments using this therapy see very few incidents of remission back to the full-blown symptoms of borderline personality disorder.
Less traditionally, but becoming more accepted by many experts in the mental healthcare community, are techniques such as meditation and mindfulness as ways to treat BPD. However, these techniques on their own, without any professional therapy whatsoever, are not recommended just off the bat. However, mindfulness can certainly play a part in reducing anger and managing one’s own emotions if practiced correctly.
Again, a message of hope is important to reiterate here. Borderline personality disorder, once correctly diagnosed and treated, can be made manageable. There is no cure to the condition, but a high percentage of those sufferers who are treated manage to see their BPD symptoms abate to a degree where they can fully function and achieve a happy, fulfilled life.
Borderline Personality Disorder in Popular Culture
Given the general lack of information on borderline personality disorder and the fact that it’s really only been known as an illness in its own right for such a short time in the grand scheme of things, it’s surprising that it arises at all in the world of pop culture. But it actually does to some extent, and there are also incidences where—in movies, for example—where BPD is featured in characters even when they don’t actually know it. Which is something like real life, actually, where many people suffer through BPD completely undiagnosed.
A great example of BPD in the movies is Anakin Skywalker—also known, of course, as Darth Vader—in the Star Wars movies. According to psychiatrists, Anakin is textbook when it comes to BPD. He has identity issues, not knowing really who he is; he has abandonment issues; he’s sometimes out of touch with reality and everyone who knows Star Wars knows that he’s something of an angry man.
The problem with many Hollywood portrayals of borderline personality disorder is that Hollywood never knew that it was portraying BPD in its movies. Anything movie made before 1980 was a movie made before the term “borderline personality disorder” was even conceived. And anything made afterwards was more coincidental than anything else. Most characters that portray symptoms of BPD also come across as violent towards others, something that the vast majority of BPD sufferers are not. So it’s worth keeping an open mind when thinking about BPD in the movies—the characters that are portrayed are overwhelmingly not typical BPD people—but they might show some of the typical characteristics that define the condition. Below are 10 movies (apart from the Star Wars franchise) that portray BPD in some sense:
- Play Misty For Me. This 1971 movie starring Clint Eastwood and Jessica Walter has Walter playing the part of Evelyn Draper, an obsessed fan of Eastwood’s radio DJ character, with anger and abandonment issues.
- A Streetcar Named Desire (1951). Blanche DuBois, played by Vivienne Leigh, shows some classic signs of reckless behavior due to earlier trauma.
- Betty Blue (1986). This French movie sees Beatrice Dalle portraying a young woman who displays overtly impulsive behavior.
- Misery (1990). Kathy Bates plays Annie Wilkes, an obsessed fan of a novelist who captures him and keeps in her house. BPD signs in Wilkes include abandonment issues and boundary problems.
- Single White Female (1992). When a girl puts a roommate ad in the paper her life turns into a nightmare when Hedra Carlson, played by Jennifer Jason Leigh answers the ad and moves in. Carlson turns out to have some major paranoia and abandonment problems, as well as issues relating to other people.
- Casino (1995). Scorsese’s epic crime thriller features Sharon Stone playing Ginger McKenna, a reckless and promiscuous drunk who displays all the classic signs of the self-destructive borderline.
- The Cable Guy (1996). Jim Carrey plays Chip, and impulsive and reckless TV cable installer who is extremely jealous and needy when it comes to other people.
- Cruel Intentions (1999). This teen movie stars Sarah Michelle Geller as a reckless cocaine addict displaying clear levels of safe-hatred beneath the perfect veneer.
- My Super Ex-Girlfriend (2006). Uma Thurman plays a superhero, G-Girl, with major abandonment problems and anger issues.
- Gone Girl (2014). This psychological thriller sees Rosamund Pike play a woman who faked her own death to get revenge on her husband.
Have you noticed something about most of these movies? Yep, the majority of the people displaying signs of BPD are women. Perhaps that goes back to the old mistaken theory that this is more of a woman’s condition than a man’s?
In real life, there are also plenty of people who have displayed at some time or the other symptoms of borderline personality disorder. Obviously without any official diagnosis it’s impossible to properly confirm that these people actually have (or had) BPD, but some contenders could include the following:
- Amy Winehouse
- Britney Spears
- Courtney Love
- Lindsey Lohan
- Princess Diana
- Angelina Jolie
All of the above ladies—yep, ladies again—have shown signs of reckless behavior, self-harm, impulsiveness, and volatile
relationships. Again, there is no proof that any of these people have been diagnosed with BPD, but there are definitely some signs there.
Borderline Personality Disorder Humor
It could be said that there’s a time and a place for all jokes, but that when it comes to borderline personality disorder there’s neither a time nor a place. It’s not the type of subject that most comedians latch onto. Most comedians have never heard of the disorder to be honest. But the internet is a fine thing, and there’s always some wag out there with a twinkle in his eye and a funny thing to say about everything, even BPD! Let’s check out what there is:
Q: How many borderlines does it take to change a light bulb?
A: It doesn’t change.
Q: Knock knock?
A: Use the doorbell, idiot!
A: I bet you think that just because you rang the doorbell, I have to let you in, jerk.
And you know what? That’s really just about what there is out there. If BPD was a comedy act it would be the one that you’re booing off the stage and throwing beer bottles at because they suck so much. Some mental conditions have a ton of humor behind them and some don’t. BPD just doesn’t. There are some cool memes though!
As mentioned above many times, there is life after BPD. People who have this condition need not be defined by it. There is a great quote about the disorder from Rachel Reiland in her 2002 book, Get Me Out Of Here: My Recovery From Borderline Personality Disorder. The quote pretty much sums up the struggle that people face, but sums it up in a beautiful way:
“You survived by seizing every tiny drop of love you could find anywhere, and milking it, relishing it, for all it was worth. And as you grew up, you sought love, anywhere you could find it, whether it was a teacher or a coach or a friend or a friend’s parents. You sought those tiny droplets of love, basking in them when you found them. They sustained you. For all these years, you’ve lived under the illusion that somehow, you made it because you were tough enough to overpower the abuse, the hatred, the hard knocks of life. But really you made it because love is so powerful that tiny little doses of it are enough to overcome the pain of the worst things life can dish out. Toughness was a faulty coping mechanism you devised to get by. But, in reality, it has been your ability to never give up, to keep seeking love, and your resourcefulness to make that love last long enough to sustain you. That is what has gotten you by.”