Twice Scarred: BPD and Secondary Wounding

It's bad enough to be a trauma survivor with symptoms of borderline personality disorder (BPD). However, sometimes people hurt us further when we reach out for help--this is called "secondary wounding".

What is secondary wounding?

According to Dr. Aphrodite Matsakis' classic I Can't Get Over It, secondary wounding can occur in many forms. People may disbelieve or deny the trauma; for example, someone may say "That could never happen" or "You're making a mountain out of a molehill." In addition to denial and disbelief, there is also minimizing. Minimizing occurs when people discount a trauma survivor's reaction to the event, saying "It shouldn't affect you this much."

Blaming the victim is also common, especially in sexual assault cases. We've all heard "Look at the way she dresses" or "She was flirting". Blaming the victim, according to Matsakis, further increases the victim's sense of self-esteem and fuels the fires of self-blame.

Stigmatization is also common. This occurs when people treat us as less of a person because of our illness. An example is "If you just had enough faith and wanted to be better, you would be."

Finally, denial of assistance is a form of secondary wounding. An example is trying to get disability benefits and being told that you weren't hurt enough.

What causes secondary wounding?

According to Matsakis, secondary wounding has several causes, including ignorance, burnout, "just world" philosophy and cultural influences.

Many times, ignorance is a cause of secondary wounding. The person simply doesn't understand. People who have never been hurt can not emphasize with someone who has been deeply wounded.

Burnout is another cause--the helping professionals may be emotionally depleted and therefore unable to empathize. They may cause secondary wounding in order to keep their own system of denial intact.

The "just world" philosophy is another cause of secondary wounding. According to this philosophy, people get what they deserve. If you are moral enough, you can avoid misfortune. If you are immoral, you will suffer. It would be nice if this were true, but it's not. As Jesus said, it rains on both the righteous and unrighteous, and the sun shines on both the righteous and unrighteous.

Finally, cultural influences can cause secondary wounding. The U.S. was founded by rugged individualists. We pride ourselves on overcoming hardship to succeed. We believe that man can be master of his own fate. Sadly, some things are out of our control--but that does not jive with the American Dream. Try being fatalistic and see what happens.

Overcoming secondary wounding

"Secondary wounding experiences can be as painful and powerful as the original traumatic event," Matsakis writes. "Just as you need to heal from that event, you will need healing for any secondary wounding experiences."

So how do we do that?

A question-and-answer session with a journal or competent therapist is a good place to start. Matsakis recommends asking the following questions:

Did it alter your views of your social, occupational, and other abilities?
Did it change your attitudes toward certain groups of people or certain institutions?
Did it affect your spiritual views?
Did it affect your close relationships with family and friends?
Did it alter your ability to participate in and belong to groups?
Did it affect your attitude toward people in general?

Which of these changes do you want to keep? Which of these changes do you want to overcome? Talk it over with your therapist. Secondary wounding can be overcome!