Borderline personality disorder (BPD) can be understood as a condition organized around paradox, rooted in early experiences of contradictory and entrapping communication. Drawing on the classic concept of the double bind, this perspective holds that many intrapsychic and interpersonal features of BPD reflect the internalization of situations in which the person "cannot win." Longed-for closeness is simultaneously feared, bids for autonomy are met with criticism, and expressions of need evoke withdrawal.
Across developmental theories and empirical findings, a consistent theme emerges. Patients with BPD often live within, and communicate through, patterns of irreconcilable injunctions. These paradoxes link psychodynamic origins, the phenomenology of splitting and unstable relationships, and the interpersonal difficulties that unfold across the life span.
Understanding the borderline personality in terms of double bind dynamics provides a coherent account of its characteristic contradictions and clarifies why the disorder so often involves intense longing paired with fear, approach followed by avoidance, and interpersonal patterns marked by impossible, no-win dilemmas.
Across developmental theories and empirical findings, a consistent theme emerges. Patients with BPD often live within, and communicate through, patterns of irreconcilable injunctions. These paradoxes link psychodynamic origins, the phenomenology of splitting and unstable relationships, and the interpersonal difficulties that unfold across the life span.
Understanding the borderline personality in terms of double bind dynamics provides a coherent account of its characteristic contradictions and clarifies why the disorder so often involves intense longing paired with fear, approach followed by avoidance, and interpersonal patterns marked by impossible, no-win dilemmas.
History and Development
In March 2025, the Bulletin of the Menninger Clinic published my paper, "Heads I Win, Tails You Lose: Interpersonal Aspects of Borderline Personality Disorder," which, to the best of my knowledge, represents the first peer-reviewed paper applying the double bind theory specifically to BPD. This followed my February 2024 article in Psychiatric Times, "Double Binds in Borderline Communication," later featured on the cover of the May 2024 print edition.
I have since expanded this line of work in papers published in several journals, including Psychodynamic Psychiatry, The Psychoanalytic Review, and the Journal of Contemporary Psychotherapy. In October 2025, John Rucker, Psy.D., and I published what we believe to be the first empirical study demonstrating that patients with personality disorders use language in ways consistent with double bind communication.
Jerold Kreisman, M.D., and I have recently submitted a manuscript outlining a comprehensive double bind theory of the development and pathogenesis of BPD. Dr. Kreisman is author of the classic bestselling book, I Hate You, Don't Leave Me.
Mark L. Ruffalo
I have since expanded this line of work in papers published in several journals, including Psychodynamic Psychiatry, The Psychoanalytic Review, and the Journal of Contemporary Psychotherapy. In October 2025, John Rucker, Psy.D., and I published what we believe to be the first empirical study demonstrating that patients with personality disorders use language in ways consistent with double bind communication.
Jerold Kreisman, M.D., and I have recently submitted a manuscript outlining a comprehensive double bind theory of the development and pathogenesis of BPD. Dr. Kreisman is author of the classic bestselling book, I Hate You, Don't Leave Me.
Mark L. Ruffalo