Borderline personality disorder · Uncategorized

Understanding borderline personality disorder

“People with BPD are like [patients] with third degree burns over 90% of their bodies.  Lacking emotional skin, they feel agony at the slightest touch or movement.”

— Dr. Marsha Linehan

Borderline Personality DisorderBorderline personality disorder (BPD) is a perplexing disorder, partly because people with this illness tend to spark deeply positive or negative emotions in those around them.  When someone with BPD likes you, you’re on top of the world.  But when you’re on their bad side, you feel as though the whole universe has turned against you.  Yet what kind of illness produces such strong reactions?  What is BPD?  What causes it, and what are the treatments?

So what’s this about BPD?

The person with BPD suffers, and they suffer profoundly.  Imagine loving your spouse one moment, hating them the next, then loving them again a few hours later — and not knowing why.  Imagine sharing your favorite movie with some friends, then having a breakdown at the thought that they might not like it?  How about pushing your loved ones away for fear they’ll abandon you? Or living in a world where everyone feels a need to “set limits” with you?  Not everyone with BPD experiences these specific scenarios, but there are some common themes you’ll find listed below.

“It’s a lot like being inside a burning building and yelling for help, while the fireman outside says, ‘what are you so upset about? Just climb over the rubble and come on out!'” — Alexander L. Chapman

In general, BPD is a psychiatric diagnosis marked by intense mood swings, problems with identity, difficulty tolerating stress, insecure relationships, and a tendency toward self-injurious behaviors.  Symptoms include:

(1) Mood swings and rejection sensitivity.  People with BPD tend to have extreme mood swings, going from happy to suicidal to angry and back to happy in a matter of hours.  Mood is very reactive, especially to perceived rejection; in fact, no matter how hard the person tries to keep themselves calm, a small slight can open a flood of painful emotion.  Feelings affects thinking and attitude, so the person’s personality itself seems to sway with each change in mood.

(2) Distorted ego and troubled friendships.  BPD sufferers struggle with an unstable self-image.  Their identity is dependent entirely on their relationship with others.  They can’t tolerate being alone. Often they go to great lengths to avoid abandonment.  Additionally, some people with BPD tend to oscillate between self-loathing and blaming others for their problems.  This causes help-rejecting behaviors and a complicated cycle of pushing people away when desperate for company.  Unfortunately, because of their illness, relationships are usually short-lived, chaotic, and problematic.

Black and white thinking(3) Black and white thinking, “playing games,” and splitting.  A major finding among BPD sufferers is the tendency to see things as all good or all bad, with little in between.  It feels like the whole world oscillates between these two extremes. Some people consciously or unconsciously “play games” to get their needs met; one example includes playing out the extremes on the people around them, choosing absolute good and absolute bad, causing people to “split” against one another in a way that benefits the patient.  Because of these behaviors, providers and families tend to respond by setting harsh “limits” on the sick person.

(4) Impulsivity, agitation, and violence towards self/others.  BPD can be associated with making quick, inappropriate decisions, decisions people later regret, like breaking a laptop computer in a fit of rage. Most patients describe problems with impulsivity.  But the most challenging aspect of the disorder is the drive individuals have to injure themselves. They impulsively cut or burn themselves to deal with stress, communicate to others that they’re hurting, or sometimes just out of boredom.  Others will use suicide as a threat, “If you don’t give me what I need, I’ll end my life.”  Unfortunately there’s a high suicide rate.  Also alarming, BPD sufferers can become extremely agitated and aggressive, especially if they feel their distress isn’t acknowledged or their needs aren’t being met.

(5)  Other characteristics.  BPD tends to produce a need for immediate gratification, as emotion and thought and desire are experienced as urgent.  People with this illness tend to struggle with feelings of emptiness.  Waiting through that emptiness until the end-goal has arrived can be almost painful.  Occasionally BPD sufferers also tend to lose touch with reality, experiencing vague hallucinations or paranoia, or feeling estranged from their surroundings.  The paranoia can be mild but widespread; people with BPD often have problems trusting others.  They constantly second-guess everyone’s intentions.

Normal versus borderline personality

We all have mild borderline symptoms from time to time, especially when stressed. Who doesn’t get rejection sensitivity when they’re blue? Who doesn’t have moments of unexplained anguish, when we say things we later regret?  And what about those deep down worries that your lover is planning to leave? Is that fear of abandonment?

The difference between normal and mild BPD can be a fine line.  Adolescents will sometimes have soft borderline features as part of their development; they typically mature out of them.  When symptoms do persist beyond the teenage years, BPD becomes a consideration, but not all “borderline characteristics” are caused by this illness.  Intense mood swings, impulsivity, reactive emotions, relationship difficulties, and suicidal thoughts can also be related to bipolar disorder.  Tendency to lose touch with reality, rage problems, irritability, and aggression are also associated with post-traumatic stress disorder.  Agitation and aggression can be found in many disorders.

The diagnosis of borderline personality disorder should be determined by a mental health provider.  Never label yourself with a mental illness based on an internet article you read!  BPD is typically diagnosed when the symptoms are chronic, widespread, problematic, destructive, and interfere with every arena of the individual’s life.  Providers usually require multiple visits before establishing a diagnosis.

“It is as if my life were magically run by two electric currents: joyous positive and despairing negative — whichever is running at the moment dominates my life, floods it.” — Sylvia Plath (note Ms. Plath might have had bipolar disorder, not BPD)

What causes BPD? 

Some theorize it’s a developmental problem, caused by a chaotic, invalidating environment during early childhood.  This is the home where a kid’s mother praises him for something on day one, then slaps him on day two for doing the same thing; where a little girl’s good behavior is ignored, but her tantrums are rewarded with food and attention; or where a child is invalidated and shamed for everything he does.  Sexual abuse is common.  In fact, most people with BPD are victims of severe, repetitive childhood trauma.

The theory of an invalidating childhood explains a lot.  If as a child you didn’t get fed unless you acted out, then you kicked and screamed often and emphatically!  Anything less would have meant starving to death.  In that situation, “kicking and screaming” worked as a necessary coping skill.  Like everyone, of course, you recycled “successful” coping skills, carrying them over into adulthood. Now you probably use that same skill to deal with most issues, despite catastrophic consequences, because no one has shown you there are kinder, healthier, cooler, less painful ways to do things.  It’s your “default” reaction, and all you know is it kept you alive all those years.

“Living with BPD is pure confusion. It’s always like, ‘Am I allowed to be upset about this thing or am I being oversensitive?'” —

Is there a therapy that’s helpful?

Coping skillsThe best talk-therapy for BPD is called dialectical behavioral therapy (DBT).

DBT is a six-month program that focuses on safety, mindful awareness, emotion regulation, distress tolerance, and interpersonal effectiveness.  The overall goal is to replace unhealthy coping skills with healthy ones.

Are medications helpful?

Although medications without therapy isn’t advised, meds are helpful.  Antidepressants and anxiety-busting medications can be helpful for depression, anxiety, suicidal thoughts, and impulsivity.  Mood stabilizers can help with mood swings, impulsivity, agitation, racing thoughts, and aggression.  Antipsychotics are helpful for reality-testing, agitation, aggression, paranoia, and mood.  Sometimes a sleep medication is used to help the individual get rest at night.

What do I do if I think I have BPD? 

Sometimes borderline personality is very close to home: you have it yourself.  If so, you don’t have to struggle with the illness alone.  If you haven’t already, reach out to a psychiatrist and therapist and get connected.  Providers may not be perfect, but they can be great advocates if you let them.  Also, if it’s offered in your community, consider signing up for a DBT course.  Alternatively, check out self-help DBT books or websites that offer free DBT resources.  Whatever you do, do get professional treatment.  The right therapy and medications can jumpstart stability and joy into your life.

“Ironically, your newly experienced vulnerability — the feeling that you are now exposed for all the world to see, that all your weaknesses are now visible — is the very thing that can save you.” — Merri Lisa Johnson

If you have more questions about borderline personality disorder, there a good online resource at the site.


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