Borderline Personality Disorder (BPD)
Borderline Personality Disorder, also known as, "Borderline" or "BPD", is characterized by intense and unstable emotions that are typically hostile, angry, or depressive in nature. BPD is the most commonly diagnosed out of the ten personality disorders. Individuals with BPD usually have a history of impulsive behavior and unstable relationships, have a fear of abandonment, and see the world in "black and white."
Individuals with Borderline symptoms may also meet the criteria for 2-3 other personality disorders, and also suffer from anxiety, depression, and substance abuse. BPD causes mood instability, interpersonal relationship difficulties, emptiness, anger, identity disturbance, alienation, and self-harm or suicidal ideation. Surprisingly, many people with BPD are high-functioning and able to to portray an impression of total normalcy.
The term "Borderline" stems from the disorder being so similar to both psychosis and neuroticism. BPD technically does not cause psychotic symptoms (hallucinations and confusion), but does produce heightened neurotic symptoms (anger, anxiety, and depression.)
Individuals with BPD have a fixed and rigid perspective of what's going on and are difficult to reason with because they are so fixed of their view of reality. Also, individuals can be delusional about what someone else is thinking about them even in the absence of any good evidence.
BPD is basically a person's own mind convincing them that their fixed view of reality of is true and everyone else's is false. Individuals with BPD have maladaptive self interpersonal functioning making it hard to get along with others. This leads to debilitating stress and a distorted self-image that impacts everyday life; thankfully, there are effective treatments available.
Causes
The exact cause of BPD is unknown, but research shows that a combination of biological and psychosocial factors contribute to its development. Each person's experience with BPD is completely different.
Research studies have shown that individuals with BPD may have differences in brain structure and function, particularly in areas of the brain involved in emotion regulation and impulse control. Childhood trauma, such as physical or sexual abuse, neglect, or separation from a caregiver, may also increase the risk of developing BPD.
Additionally, social factors, such as a lack of social support or a history of chaotic or unstable relationships, may contribute to the development of BPD. While these factors may increase the risk of developing BPD, not everyone who experiences them will develop the disorder.
Signs + Symptoms
The symptoms of BPD are similar to those of other types of personality disorders, but can vary from person to person. Symptoms are on the borderline between psychosis and neuroticism.
Some common symptoms:
- Intense and unstable emotions, such as anger, sadness, anxiety, or irritability.
- Impulsive behaviors, such as substance abuse, binge eating, or reckless driving.
- Distorted self-image, such as feeling like you don't know who you are or what you want.
- Unstable relationships with others, often vacillating between idealizing and devaluing others.
- Fear of abandonment or rejection.
- Self-harm or suicidal behaviors.
- Chronic feelings of emptiness, loneliness, or boredom.
- Difficulty regulating emotions or coping with stress.
- Dissociation or feeling disconnected from reality.
- Alienation from your self, family members, and society.
Diagnosis
A diagnosis of BPD can be made by seeing psychiatrist, psychiatric nurse practitioner, and licensed mental health counselor or therapist by performing a comprehensive patient history and diagnostic screening tools.
The diagnostic criteria for BPD includes the presence of intense and unstable emotions, impulsive behaviors, and unstable relationships. In the past, BPD was diagnosed using a categorical system and symptom analysis; however, it's transitioning towards a less complex, dimensional approach of measuring a person's ability to manage self in interpersonal relationships.
A mental health professional can help determine whether an individual's symptoms meet the diagnostic criteria for BPD or another mental health condition, and develop a treatment plan that is personalized to their needs and goals.
Treatment
There is no single treatment that works for everyone with BPD, and finding the right treatment plan can take time and patience. Treatments include medications and psychotherapy, such as dialectical behavior therapy (DBT) and cognitive-behavioral therapy (CBT).
CBT is a type of talk therapy that focuses on identifying and changing negative thought patterns and behaviors. DBT focuses on teaching skills to help manage emotions, improve interpersonal relationships, and cope with stress. DBT has been shown to be effective in treating BPD. Medications, such as antidepressants or mood stabilizers, may need to be taken for an extended period of time or even indefinitely to help manage symptoms of impulsivity, depression, and anxiety,
The length of treatment varies depending on the individual's needs and the type of treatment they receive. Psychotherapy can last for several months to several years, depending on the severity of the symptoms and the progress made in therapy.
The success of treatment depends on the individual's willingness to engage in therapy and their level of motivation to overcome their symptoms. True healing requires awareness, time, and consistent effort.
It's important to note that BPD is a chronic condition, and while symptoms can be managed with treatment, they may never completely go away. It's essential for people with BPD to continue working with mental health professionals to manage their symptoms and prevent relapse.
How To Help Someone with BPD
BPD is a complex disorder that makes it difficult for individuals to control their emotions and have stable relationships with family members, friends, and coworkers. People with BPD have sensitive temperaments and "thin" skin. Helping these individuals requires compassion, understanding, and patience.
In order to first support these individuals, educate yourself on what BPD is and how it affects them, and learn what their triggers are. This will help you to build empathy, gain knowledge about what behaviors are common, and identify what may be driving these actions.
Create a validating environment with a balance of needs that need to be met and rules that need to be followed. When helping a family member with BPD, you have to take the time to slow down and remind them of their positive traits. Always, offer ongoing support and encourage them to seek professional mental help.
Final Thoughts
BPD can be a very challenging and debilitating condition to treat and live with because it creates this rigid, distorted perspective of reality in the mind that is true to the individual. This makes it tough to maintain stable relationships and function in everyday life. The intense and unstable emotions cause significant anxiety, anger, alienation, fear of abandonment, relationship problems, and identity crisis. Be aware that individuals with BPD suffer in silence and can constantly feel like they are trapped inside their bodies and feel like screaming.
If you or someone you know is struggling with BPD, or any other mental health condition, please seek professional help from a licensed mental health professional. Always remember, that you do not have to wait until symptoms are overwhelming or out of control to seek help. Do not suffer or just try to keep pushing through. Reach out to family and friends and talk about your concerns with your primary care provider, who can refer you to a mental health professional.
If you or someone you know is struggling or in crisis, help is available. Call or text 988 or chat 988lifeline.org to reach the 988 Suicide & Crisis Lifeline.
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