Understanding Borderline Personality Disorder

Understanding Borderline Personality Disorder

Separating the myths from the facts of one of the most misunderstood mental health conditions.

— by Kyle Lakey

Borderline Personality Disorder (BPD) is a mental health condition that affects approximately 1.6% of adults in the United States. It generally begins to manifest in early adulthood and is more commonly diagnosed in women than in men. BPD is classified as a severe mental illness characterized by intense emotions, unstable relationships, and impulsive behavior, and it can be debilitating and even dangerous. Unfortunately, BPD is often misunderstood and stigmatized, leading to harmful myths and misconceptions.

Myth 1: People With BPD are Manipulative and Attention-Seeking

One of the most harmful myths about BPD is that people with this condition are manipulative and attention-seeking. This misconception can be particularly damaging because it can lead to social isolation and further stigmatization, painting individual people as dangerous characters. In reality, people with BPD often struggle with intense emotions and may engage in impulsive behavior as an unfortunate coping mechanism. While it may appear that they are seeking attention, this is often not the case.

BPD alters moods, behavior, and thinking and impacts relationships, careers, and social interactions, often resulting in anxiety, depression, and anger. People with BPD describe it as being on an emotional rollercoaster, often struggling with their self-image and goals. Inappropriate impulsive behavior and mood swings can make it difficult for people with BPD to maintain healthy relationships. People with BPD often feel misunderstood and alone, and it is important to recognize that people with BPD are not manipulative but instead may be struggling with their emotions in a way that is difficult for others to understand.

Types of BPD

There are four primary categories in classifying the types of BPD. These include:

• Impulsivity: These individuals can be attractive and charismatic, typically seen as risk-takers. However, their behavior is dramatic and unpredictable and can be harmful.
• Discouraged: Often seen as clingy and lacking confidence, these individuals are prone to depression and a sense of powerlessness and worthlessness.
• Petulant: These individuals can be highly critical and easily disappointed. Their sense of self is easily undermined, and they take offense easily. Paranoia and suspicion are additional symptoms.
• Self-Destructive: These individuals are inclined to be highly self-critical to the point of loathing. This leads to self-destructive behavior as their anger is turned toward themselves, and suicide is a significant risk.

Myth 2: Everyone with BPD Has the Same Symptoms

BPD is a complex condition that can manifest in a variety of ways. While there are common symptoms, such as intense emotions and unstable relationships, not everyone with BPD will experience these symptoms in the same way. In fact, BPD can often co-occur with other mental health conditions, such as depression and anxiety. It is important to recognize that each person with BPD is unique and may require individualized treatment. This may include a combination of therapy and medication or other approaches as determined by a mental health professional.

Symptoms of Borderline Personality Disorder

Some BPD symptoms may be similar to other severe mental illnesses like bipolar and complex PTSD. When a mental health professional is looking into a diagnosis for BPD, they will refer to the symptoms based on self-image, emotional regulation, impulse control, and social interactions. There are nine main BPD symptoms.

Fear of Abandonment

People with BPD will often fall in love very quickly and seem to rush into relationships. When trouble brews, a person with BPD will often resort to extreme measures to try to prevent their partner from leaving. This behavior is caused by their intense fear of abandonment or being alone.

Unstable Self-Image

People with BPD may swing from self-acceptance to self-loathing, with no clear sense of identity. This results in frequent job changes, relationship upheavals, changes in religious beliefs, shifting goals or values, and even changes in sexual identity.

Impulsive Behavior

Impulsive and often harmful behavior is common with BPD. A person with BPD may indulge in risky behaviors, including drug or alcohol abuse, reckless driving, irresponsible sexual behavior, shoplifting, binge eating, and impulse spending.

Self-Harm

People with BPD may self-harm through cutting or burning or more extreme behavior, such as suicidal thoughts or attempts. In many instances, these reactions are in response to anxiety over rejection or abandonment. There can also be self-sabotaging attempts to abandon promising careers or disconnect from beneficial relationships.

Emotional Instability

BPD is often associated with extreme mood swings. Quickly switching from extreme happiness to intense sadness is common, although the episodes are often fleeting, lasting minutes or sometimes a few hours. Emotional triggers can result in fast, extreme reactions to things that would not commonly affect others.

Unstable Relationships

It is not uncommon for BPD relationships to be brief and tumultuous, starting with idealization and seemingly instant love of the other but rapidly devolving into anger and hate when things go wrong. They are also capable of unexpectedly cutting ties with someone they may have seemed obsessed with.

Feeling Empty

In many cases, relationship problems are connected to feelings of emptiness, which BPD sufferers try to fill through fleeting relationships with others, as well as food, drugs, or sex. Many describe themselves as feeling like they are worthless or like no one cares about them.

Paranoia and Suspicion

Constantly questioning people’s motives is another symptom of BPD. Stress exacerbates the situation and brings with it feelings of disassociation or losing touch with reality. In some more severe cases, a person with BPD may suffer from delusions.

Anger Issues

Flares of anger are common BPD symptoms, with tempers spiraling quickly to rage. These often devolve into physical fights or may simmer as consistent bitterness or sarcasm until the storm blows over. While this manifests externally, many people with BPD spend a lot of time being angry with themselves.

Co-Occurring Mental Health Conditions

While many people with BPD may experience similar symptoms, the condition can manifest in a variety of ways, and each individual may have a unique set of challenges and needs. One of the factors that can complicate the management of BPD is the presence of co-occurring mental health conditions.

Research has shown that BPD often co-occurs with other mental health conditions, such as depression, anxiety, and substance use disorders. In fact, approximately 80% of people with BPD also meet the criteria for another mental health condition. These co-occurring conditions can make BPD more difficult to manage and may require specialized treatment approaches. For example, someone with BPD and a co-occurring substance use disorder may benefit from integrated treatment that addresses both conditions simultaneously.

It is important for individuals with BPD to work with a mental health professional to identify any co-occurring conditions and determine the best treatment approach for their unique needs. By addressing all of the conditions that an individual is experiencing, treatment can be more effective and lead to better outcomes.

Myth 3: BPD is Untreatable

Another common myth about BPD is that it is untreatable. While BPD is a complex condition that can be difficult to manage, there are effective treatments available. Dialectical Behavior Therapy (DBT) is a type of therapy that has been shown to be effective in treating BPD. DBT focuses on teaching people skills to manage their emotions and improve their relationships. In addition, medication can also be helpful in managing symptoms of BPD. It is important to note that finding the right treatment approach may take time and may require working with a mental health professional to find what works best for each individual.

Treating BPD

People with BPD respond well to long-term therapy, where they learn new self-soothing and emotional regulation methods, essentially rewiring their neural pathways to help manage their reactions to life’s ups and downs. In addition to therapy, medication can also be helpful in managing specific symptoms of BPD, such as mood instability or anxiety. However, medication should not be seen as a cure for BPD, and it is important to work with a mental health professional to determine the appropriate medication and dosage. When treating BPD, therapy has proved to be more effective than medication.

Dialectical behavior therapy (DBT) is a comprehensive, evidence-based treatment for borderline personality disorder. DBT is a type of talking therapy based on cognitive behavioral therapy (CBT), but it’s specially adapted for people who feel emotions very intensely.

While Dialectical Behavior Therapy (DBT) is a commonly used treatment approach for BPD, there are several other treatment options that may be effective as well. These include Cognitive Behavioral Therapy (CBT), Schema Therapy, and Mentalization-Based Therapy (MBT). Each of these approaches has its own strengths and limitations, and the best treatment approach for an individual with BPD will depend on their unique needs and circumstances. It is also important to note that finding the right treatment approach for BPD may take time, and it is common for individuals to try several different approaches before finding what works best for them.

Therapy

• Dialectical Behavior Therapy (DBT): DBT is a form of psychotherapy or talk therapy. It serves to teach emotional regulation, stress management, and relationship development.
• Cognitive Behavioral Therapy (CBT): CBT is a form of therapy used in the treatment of BPD. It is a type of talk therapy that focuses on changing negative patterns of thinking and behavior.
• Schema-Focused Therapy: This therapy is based on identifying an individual’s fundamental patterns of interacting with the world and incorporates elements of cognitive behavioral therapy and other types of psychotherapy to create healthier coping mechanisms.
• Mentalization-Based Therapy (MBT): The goal of MBT is to enhance an individual’s ability to understand and interpret the mental states of themselves and others and to use this understanding to improve their relationships and overall well-being.

Life Skills Education

• Self-Calming Techniques: These include skills such as mindfulness and meditation, sensory stimulation by focusing on input from one of the five senses, and managing emotional vulnerability by incorporating healthy lifestyle habits.
• Impulse Control and Distress Management: Managing abnormalities in brain structures related to the regulation of emotion, impulse control, and aggression. Research indicates that managing irregularities in brain chemicals such as serotonin helps regulate mood.
• Improving Interpersonal Skills: Taking responsibility and managing assumptions, understanding other perspectives, and developing communication skills can assist in building healthier relationships.

Medication

There is currently no FDA-approved BPD medication. However, healthcare specialists may prescribe medication to treat coexisting conditions such as:

• Depression or bipolar disorder
• Panic attacks or anxiety
• Hallucinations or paranoia
• Suicidal thoughts or urges to self-harm or harm others

Breaking the Stigma

The stigma surrounding BPD can make it difficult for people with the condition to seek help. It is important to recognize that BPD is a serious mental health condition that deserves compassion and understanding. By breaking the stigma and separating fact from myth, we can better understand and support people with BPD. It is important to recognize that BPD is a treatable condition, and with the right support and treatment, people with BPD can lead fulfilling lives.