What You Need to Know About Borderline Personality Disorder
Many misconceptions exist surrounding borderline personality disorder (BPD), it’s symptoms and causes, and what makes it different from other mental health conditions. Estimates state that it affects about 1.6% of the population, 75% of which are women.
BPD belongs to the class of mental health conditions called personality disorders due to the nature of the illness as chronic, with long-term patterns of maladaptive behaviors, emotions, and thoughts that vary from the expectations of his or her culture. These behaviors often interfere with one’s ability to function in relationships, work, and other settings.
The hallmark feature of BPD is in one’s difficulty regulating their emotions, and ineffective communication strategies often played out in relationships, as popularized through the saying and popular book on the subject, “I hate you, don’t leave me”.
1. Signs that someone may be struggling with BPD include an unstable pattern of relationships, poor self-image, difficulty in regulating emotions, and engaging in high risk behaviors.
At its core, BPD affects how one perceives themselves and others, and stems from a difficulty in managing emotions. In this way, BPD is made up from a collection of symptoms that result from one’s inability to manage themselves in four key areas.
Dysfunction in these areas is enduring and life-long, and while some individuals may display some of these behaviors and not others. However, to receive a diagnosis of BPD, the symptoms need to be significant and persistent.
Relationships. BPD is thought to be fueled by an underlying fear of abandonment that dictates one’s behavior in all relationships. Thus, feelings tend to rotate between extremes of love and idealization of one’s partner, and quickly turn to dislike, anger or even hatred towards them. This approach towards relationships often leaves in its wake conflict, arguments and estrangement from loved ones and love interests alike. Research points to the fact that those with BPD symptoms usually have a greater number of romantic relationships over time, as well as a higher likelihood of unplanned pregnancies in women.
Diving deeper into the felt experience of someone with BPD, it is their insistence of avoiding abandonment at all cost that drives them to push others away themselves first, in order to bypass the alternative outcome of being left themselves. Often, they allow their minds to fixate on inconsequential details that they may believe represents a threat to their safety in the relationship, and justifies their actions. However, they may also withdraw from relationships when feeling smothered or fearful of intimacy. The result is a cyclical pattern between demands for love or attention and sudden withdrawal or isolation.
Self-image. Frequently reported by individuals with BPD are disturbances of identity, or the experience of a poor or unstable sense of self. Practically this may look like a difficulty in describing themselves coherently and relying on less grounded representations of self and others. In fact, those with BPD were likely to describe themselves in positive and altruistic ways despite their aggressive impulses, pointing to a blind spot in their self-concept.
However, other studies point to the higher incidence of lowered self esteem reported in those with BPD. This is in addition to reports of feeling blank or empty that results from the delayed identity diffusion, and dissociation, or feeling cut off from oneself or reality. These changes in cognition regarding oneself parallel the patterns of dysregulation evident in all aspects of BPD.
Mood Disturbance. As previously discussed, one’s inability to regulate emotions is paramount to their BPD diagnosis. Regarding mood, this typically looks like extreme shifts that last hours to days. It is hypothesized that those with BPD experience emotions intensely, and for such extended periods of time so that it is more difficult for them to return to their normal affective state. They may appear to be very reactive and are no stranger to the feelings of anger, anxiety, and overwhelming emptiness.
Difficulty controlling their anger may present it’s own challenges, as studies on the course of anger in individuals with BPD and those without confirm the notion that those with BPD experience their emotions for an increased duration of time. One such explanation is that this appears to stem from rumination behaviors that keep someone stuck in their angry (or sad, or anxious) thoughts, and eventually lead to actions.
High Risk Behaviors. Oftentimes, an individual dealing with chronic emotional dysregulation, as is common in BPD, will have developed some ineffective problem-solving skills in order to deal with their emotions. Typically this tends to look like heightened suicidality, especially regarding the tendency to self- injure. The generally accepted figure estimates that 65-80% of the BPD population engage in some form of non-suicidal self injury, and that 8-10% of people with BPD will die by suicide.
Impulsive behavior may involve other high-risk behaviors such as spending excess amounts of money or engaging in unsafe sexual encounters, however all of these behaviors appear to function similarly in their role for the person with BPD. Engaging in any of these behaviors may provide the instantaneous relief sought out for deep emotional suffering.
2. Risk factors for developing BPD stem from a mixture of genetics, brain development, and environment.
Researchers agree that while there is no conclusive evidence pointing to a singular cause of BPD, a mixture of the factors listed above appear to allow them to arrive at the greatest understanding. Genetics and heredity can be thought of as contributing to the likelihood one might develop BPD, as it has been found to be five times more common in individuals who have a close relative living with the disorder.
This alone is typically not enough to cross the threshold into disordered behavior, and research shows that those who have experienced traumatic life events, especially abuse or abandonment in childhood significantly increases susceptibility. Studies estimate that 40-71% of those with BPD have been sexually abused, and many others have been exposed to unstable and chaotic environments.
Further still, research shows that some impaired functioning of brain structures intended to experience and regulate emotions (i.e. the amygdala and prefrontal cortex) has been found in individuals with BPD. This highlights the existence of some biological basis for the maintenance of BPD, and the potential for use of medication in its treatment.
3. Treatment options have improved in recent years, and may include a combination therapy and medication.
Originally, those diagnosed with BPD experienced a great deal of stigma not only from the general population, but also from treatment practitioners as having an especially difficult disorder to treat. As stated previously, all of someone with BPD’s relationships are characterized by the intense ebb and flow of love and anger, the therapeutic relationship notwithstanding.
It may be difficult not to view someone with BPD’s erratic and extreme moods as intentional attempts at manipulation, however, by focusing on acceptance and validation, a therapist may forge a healing bond with that client that is the turning point of change.
Specifically developed to assist those with BPD build their ability to accept and be mindful of their emotional state is the treatment modality called dialectical behavior therapy. In using a combination of mindfulness and coping skills, clients learn to withstand their powerful emotions, and learn tools to respond better to them.
Medications may be used in conjunction with therapy, as mood stabilizers have been found to be the most effective in leveling emotional instability. Of course, those with a co-occurring disorder may also be prescribed medications to treat those conditions along with the BPD.
At Nsight Psychology and Addiction we provide both residential and intensive outpatient programs (IOP) for mental health conditions like Borderline Personality Disorder and can provide you or your loved one with the care that they need to overcome these destructive patterns. Contact us today to get started!
Written by Rachel O’Connor, at Theory About That