Understanding Borderline Personality Disorder

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Borderline Personality Disorder (abbreviated BPD) has a very bad name, mostly because it is difficult to understand. I talked about Personality Disorder Myths last week and briefly mentioned a few common misunderstandings about BPD.
For example, there are very few named portrayals of characters with Borderline Personality Disorder. The primary example is Girl, Interrupted, where Winona Ryder plays a woman with Borderline Personality Disorder (which is a terrible portrayal of Borderline).
It is difficult to adequately show what personality disorders are really like because it is best understood over  time. For instance, Morello from Orange is the New Black mostly likely suffers from Borderline Personality Disorder, if not a combination of disorders. If you’ve watched the show in its entirety, you’ll be able to see the wide range of reactions she has to people, experiences, and more. Morello has the best quote about living with a personality disorder that I have ever run across:

“I’m f*cking everything up, okay? It’s happening again. I’m watching it happening and I can’t stop myself.”

 

Borderline Between…

The name Borderline Personality Disorder originally came from the idea that people with Borderline Personality Disorder constantly acted on the border or neurosis and psychosis. Psychologists originally identified people with Borderline by their chaotic behaviors and responses (neurosis) to the point it often felt they had lost touch with reality (psychosis).
Over 20 years ago, Dr. Kreisman and Hal Straus wrote a self-help book about Borderline Personality Disorder entitled “I Hate You-Don’t Leave Me.” The title says everything about what living with BPD (or living with someone with BPD) is like. As a person on the outside, you often feel crazy during or after interactions.
As the child of someone with Borderline, I can tell you it is difficult to support someone close to you with BPD. Often, interacting with someone with Borderline Personality Disorder for long periods of time will make you feel crazy, either from the drastic changes in mood and response, or lack of predictability of the other person. What is most commonly focused on with Borderline Personality Disorder is a lack of emotional regulation.
 

Diagnostic Information

In order to be diagnosed with any personality disorder, you must meet criteria for both a general personality disorder, as well as the criteria for the specific personality disorder.
 

General Personality Disorder Criteria

Unlike other mental health disorders, personality disorders all have the same core criteria. There are 5 core criteria that must be met, as well as criteria for the specific personality disorder. The 5 core criteria are:

  • Significant impairments, problems with self-identity or self-direction, as well as interpersonal functioning (think intimacy or ability to empathize)
  • One or more pathological (“bad”) personality trait (detachment from others, disinhibition, antagonism, psychoticism, or negative affectivity)
  • The same impairments are relatively stable across situations and time
  • The impairments are not better explained by the normal developmental stage or the culture of the person
  • The impairments are not due specifically to drugs or another medical condition (such as trauma to the head)

 

Borderline Personality Disorder Criteria

To be diagnosed with Borderline Personality Disorder, you must have a continuous pattern of unstable relationships (friends, family, work, romantic, etc.), unstable self-image, unstable mood (frequent changes), and significant impulsivity. This must also begin by early adulthood and must be present in many different situations (church, home, work, etc.).
In addition, you must have at least 5 of the following:

  1. Frantic efforts (wild, chaotic, disorganized) to avoid real or imagined abandonment (does not include suicidal or self-harming behavior)
  2. Pattern of intense, unstable relationships that frequently shift between extremes
    • Going from worship to hatred or vice versa
  3. Identity disturbance, such as ever-changing/unstable sense of self or self-image
    • Often presents as rapid career changes, sexual identity, morality, or types of friends
  4. Impulsivity in at least 2 self-damaging areas
    • Sex, spending, reckless driving, substance abuse, binge eating, etc.
    • Does not include suicidal or self-harming behavior
  5. Recurrent suicidal behavior, gestures, or threats, OR self-harm
  6. Inability to control or cope with moods
    • Extreme reactions, usually lasting anywhere from a few hours up to a few days (rare)
  7. Chronic feelings of emptiness
  8. Inappropriate, intense anger or difficulty controlling anger
  9. Fleeting stress-related paranoid thinking or severe dissociative symptoms
    • Out-of-body experiences, or similar to watching your actions on a TV screen without control of actions

 

Common Struggles

Many reactions of people with BPD are due to their patterns of interpreting situations. For instance, the first criterion (avoiding abandonment), their behaviors are often due to their perception that if the person leaves their presence, even temporarily, that means that the person with BPD is “bad.” As a result, many people with BPD engage in frequent manipulative behaviors to attempt to prevent being alone.
Often, people with Borderline Personality Disorder cannot tolerate being alone, often resulting in extreme reactions, such as suicidal threats or threats of hurting themselves.  This behavior is called emotional blackmail, and while it is exhausting to replay the same situation repeatedly, it is important to take all threats of suicide or self-harm seriously.

If you or someone you know is experiencing thoughts of suicide, please contact your local emergency service providers, 911, or call a national hotline such as the National Suicide Prevention Hotline at (800) 273-8255.

 

Cause

There is no definitive cause for Borderline Personality Disorder. There is a relationship between people who experience trauma during childhood and developing Borderline Personality Disorder but does not have significant evidence to support this relationship.
There is a moderate genetic component, as well. A person is 5 times more likely to develop BPD if they have a first-degree relative (parent or sibling) with BPD.
 

Treatment

 
Medications are rarely effective in treating personality disorders.
The only evidence-based treatment for BPD is Dialectical Behavioral Therapy, affectionately called DBT. This model focuses on regulating emotions, often a primary issue for people with BPD. I use this DBT Therapy Skills Workbook when working with clients and running groups on emotional regulation.
In addition to structured group therapy, individual and family therapy can be beneficial to both the individual and those close to them.
Finally, it is incredibly important for the supports of a person with BPD to educate themselves about Borderline Personality Disorder. I’ve included several of my favorite books below (clickable):

I Hate You, Don't Leave Me
$11.79 on Amazon
$10.27 on Amazon
$12.71 on Amazon
 
 
 
 
 
 
$11.97 on Amazon
$11.25 on Amazon
$12.35 on Amazon
 
 
 
 
 
 
The last book, The Body Keeps The Score by Bessel Van Der Kolk, isn’t a book specific to BPD. My Marriage and Family Therapy supervisor frequently references this book for working with people with trauma, often experienced by people with BPD.

Facts

  • Borderline Personality Disorder is significantly more common in women than men. 75% of people diagnosed with Borderline are female.
  • 8-10% of people with Borderline Personality Disorder commit suicide.
  • Borderline Personality Disorder and Bipolar Disorder are often misdiagnosed because of their many overlapping symptoms.
  • People with Borderline Personality Disorder often have more than one mental health diagnosis.
    • Most common are Major Depressive Disorder, Bipolar Disorder, substance abuse disorders, PTSD, eating disorders, ADHD, and other personality disorders.
  • Borderline Personality Disorder is often not diagnosed until adulthood due to the identity development stage of adolescence.

Understanding Borderline Personality Disorder
 

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6 thoughts on “Understanding Borderline Personality Disorder

  1. This post is really spot on. I have a close relative with BPD and it has honestly been the worst experience in my life. Even knowing everything you’ve written – recognizing the signs and their behavior patterns – it’s pretty hard (or sometimes impossible) to understand them or keep them in your life, as they literally drive you insane. Not trying to exaggerate or be rude, I really mean literally, as so many of their closest people end up in therapy because of the emotionally/physically abusive nature of their relationships.
    I’m glad that it’s being talked + written about more and more, because I think it’s so important for people to realize what’s happening to them, or to someone they love. But with BPD there are indeed many, many limitations when it comes to getting proper help. Sadly.

    1. Luna,
      I know exactly what you mean. I also have a close relative with BPD and it’s exhausting trying to spend time with them. It takes an overwhelming amount of effort to try to remember everything you’ve read about BPD when you’re with them. And what’s worse is having to prepare to interact with them. It’s incredibly difficult to have a long-term relationship with someone who has BPD due to the chaos, constantly shifting from one extreme to the other. It’s what we in the therapy business refer to as “crazy-making behavior.” I find the most helpful thing to remember about people with BPD is they almost always have a history of trauma.

  2. Thanks for getting the message out. I am a recovering BPD. It’s cool that the book you use to help your clients is mindfulness based. Mindfulness has literally given me my life back and I only wish I’d learned about it sooner.

    1. I’m really glad to hear about your recovery! I’m a firm believer in mindfulness as a therapeutic tool and I’m so happy it is helpful for you. Thank you for stopping by and sharing! I really appreciate it!

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