Understanding and Coping with Borderline Personality Disorder
The month of May marks the start of Mental Health Awareness Month, and with that comes an opportunity to discuss mental health diagnoses of all kinds. Within recent years, borderline personality disorder, commonly shortened to BPD, has received more attention as a longstanding misunderstood, and wrongfully stigmatized diagnosis.
What is BPD?
Personality disorders are a distinct form of diagnoses that are defined by long-lasting, deeply ingrained patterns of behavior that have a notable effect on the way an individual perceives themselves and others. Often, a personality disorder leads to higher levels of difficulty in maintaining close relationships with others and makes existing in the larger society more difficult. Borderline personality disorder (BPD) is a personality disorder that is marked by several key symptoms, namely intense, volatile emotions that shift rapidly, challenges within interpersonal relationships, and difficulty maintaining a stable sense of self.
Other key symptoms include:
Intense fear of abandonment in relationships: Individuals with BPD often report severe uncomfortability being alone, which results in intense emotions of fear or anger when they perceive abandonment from a partner or significant figure in their life.
Volatile and unstable relationships: Those with BPD often experience rapid shifts in the way they view those close to them, this is known as “splitting” and can be best described as idealizing someone one moment to then devaluing them the next.
Impulsive behaviors: Behaviors that are performed on a whim and often considered reckless are often reported.
Emotional volatility: BPD is characterized by intense swings in emotion, changing frequently and suddenly and affecting how individuals feel about themselves, others, and the world around them. Individuals with BPD often report experiencing intense anger, and have difficulty controlling this emotion.
Repeated self-harm or suicidal behavior: People with BPD may engage in self-injurious behavior such as cutting, burning, or hitting themselves. These individuals may also experience suicidal thoughts and urges.
Chronic feelings of emptiness: Individuals with BPD often report persistent feelings of sadness, boredom, lack of fulfillment, and general “emptiness”.
Why does BPD develop?
Often, personality disorders are portrayed as manifestations of manipulative, conniving behavior. However, it is important to remember that media portrayals of the diagnosis are often both heavily stereotyped and inaccurate. Personality disorders of all types, including BPD, develop and are maintained for a variety of reasons. Based on current research, findings indicate that the development of BPD is most likely a combination of genetic and environmental factors. Studies have shown that BPD tends to run in families, meaning some individuals may be born with a natural predisposition to developing the disorder. However, it is also important to note that the majority of individuals diagnosed with BPD have experienced some form of physical, sexual, or emotional trauma, usually in childhood. The correlation between the two has led to the belief that trauma plays an underlying role in the development of the diagnosis.
The Stigma
As humans, we learn to respond to the environments we exist in. As a result, we can create longstanding patterns of thought, behavior, and emotional responses as methods of surviving. It would be fully incorrect to assume that the diagnosis of BPD is as simple as the stereotypes of someone who is “too much” or “crazy”. Individuals with BPD are experiencing deep, painful emotions that they often do not know how to cope with. Often, they recognize the difficult effects of their words and actions on their close friends and family, but feel they have no control or ability to make meaningful, long-lasting changes.
If you suspect or know that you have a diagnosis of BPD, or you know a loved one with this diagnosis, it is important to remember to approach these symptoms with compassion. If you are an individual with BPD, know that treatment is possible and available. It takes time to learn new ways of thinking, feeling, and behaving, and a consistent commitment to treatment allows the opportunity to grow and heal. And for those with a friend, family member, or partner diagnosed with BPD, compassion is as important as consistent, stable boundaries for both this person and yourself.
Treatment
At this time, BPD symptoms have proven to respond effectively to psychotherapy. A popular modality is that of Dialectical Behavior Therapy (DBT), specifically developed for those with a BPD diagnosis. DBT focuses on emotion regulation, distress tolerance, mindfulness skills, and the development of interpersonal skills. Cognitive Behavioral Therapy (CBT) and group therapy can also be helpful approaches.
Prescription medications can sometimes be considered for the treatment of individual symptoms of BPD, but are not considered a frontline approach, as their effectiveness for BPD has not been proven or studied sufficiently.
First Steps
If you or a loved one is struggling with BPD, there are steps to take. Work to learn and educate yourself and others regarding the diagnosis and how it presents.
Educate yourself and others about BPD: Knowing more about BPD allows us to move past stigma and fear, and begin working to understand symptoms with curiosity is a meaningful first step in creating positive change.
Approach the diagnoses with empathy: As with all diagnoses, empathy and care creates an environment where individuals can open up about their experiences with the symptoms and create a comprehensive, supportive dialogue moving forward.
Advocate for access to evidence-based, trauma-informed treatment
This May, we honor Mental Health Awareness Month, and do so by holding space for the full range of human experiences. Understanding BPD isn’t just about diagnosis, it’s about seeing the humanity in people who have often felt unseen.
Healing happens in connection. Awareness is the first step.
