Borderline Personality Disorder

Written by: Samantha Bird; 23-09-2024

What is BPD?

Personality disorders are organised into 3 categories: A (eccentric), B (emotional/dramatic), and C (anxious). Borderline personality disorder (BPD) is a cluster B disorder. Marked by drastic emotional extremes, intense fear of abandonment, rage, impulsivity and switching between intensive adoration (idolization) and despising (devaluation) of an individual (favourite person); this switch is called splitting. It is a coping mechanism involving labelling a formerly beloved person as despicable in order to shift guilt or avoid being hurt. BPD is a partially hereditary disorder, often also caused by childhood trauma. It is diagnosed more in women than men and the onset tends to occur in early adulthood.

Due to the disorder’s tendency to induce episodes of impulsive rage, BPD is heavily stigmatized. Often, sufferers are labelled as toxic or overdramatic. However, in the vast majority of cases, this is outside of the person’s control and stems from their own state of suffering. Friends or partners of someone with BPD are encouraged to be patient, informed and understanding. Still, it is important to note that others can still be affected by the actions of a BPD sufferer and being understanding should not mean either person should relinquish healthy boundaries.

There are different types of BPD a person can have depending on their symptoms. These include:

Impulsive BPD- marked by energy, binging, being quick to anger and reckless hedonistic behaviour

Discouraged/quiet BPD- resembles ‘Dependent personality disorder’ in many ways. Sufferers are often high functioning, desperate to avoid break-ups, self-critical, and struggle connecting with others.

Self-destructive BPD- similar energy and behaviours to impulsive BPD, but distinguishable by bitter self-hatred, self-harm and suicidality.

Petulant BPD- characterised by mood swings, passive aggression, ‘sulky’ behaviours and lack of patience.

How do I know if I have BPD?

(CW: SELF HARM, SUICIDE )

to be diagnosed a person must meet 5 of the following 9 DSM criteria :

Frantic efforts to avoid real or imagined abandonment

A pattern of unstable and intense interpersonal relationships characterised by alternating between extremes of idealisation and devaluation

Identity disturbance: markedly and persistently unstable self-image or sense of self

Impulsivity in at least two areas that are potentially self-damaging (e.g. spending, sex, substance abuse, reckless driving, binge eating)

Recurrent suicidal behaviour, gestures, or threats, or self-mutilating behaviour

effective instability due to a marked reactivity of mood (e.g. intense episodic dysphoria, irritability or anxiety usually lasting a few hours and only rarely more than a few days)

Chronic feelings of emptiness

Inappropriate, intense anger or difficulty controlling anger (e.g. frequent displays of temper, constant anger, recurrent physical fights)

Transient, stress-related paranoid ideation or severe dissociative symptoms

^ DSM-5 p663

Some Key Misconceptions ABOUT bpd:

CW: SELF HARM, SUICIDE

Misconception 1: people with BPD are toxic and lack empathy: often sufferers only register the consequences of their impulsive anger, attachment, or 'split' after it has already taken place. It should be noted that these traits are often a result of a traumatic childhood outside of the sufferers control, and that their symptoms cause them a lot of suffering. Often behind the insults and rage, there is a person cutting themselves, crying and maybe even attempting to end their life.

Misconception 2: BPD sufferers just want attention: although hedonistic or anger responses are very public, most extreme behaviour such as starvation induced by anorexic/suicidal thoughts are private obsessions driven by self-hatred. Others like cutting can be an escape from more public affairs that, while merely upsetting for others, can trigger a majorly depressive episode for a BPD sufferer, such as being left out of an event. Moreover, while behaviours like suicide are often genuine intentions, some cases can be a plea for attention. However, this should not be stigmatised; often, BPD sufferers are desperate to hold onto friends or partners who may attempt to pull away from them. In the mind of someone with the disorder, the only remaining option is to guilt-trip the person into giving them attention through extreme actions. Even the slightest withdrawal of attention from certain people could trigger extreme depression or even suicide, so to a sufferer an attention-seeking behaviour may appear worth the trouble.

Misconception 3: someone with BPD will never get better: while a lot of advice and therapy is directed towards coping with symptoms throughout the person's lifetime, sufferers can sometimes recover from some or even all of their symptoms. Medication can help reduce or eliminate some elements of the disorder, as can therapy. It is also important to note that BPB sufferers can sometimes be drawn into unhealthy, toxic or abusive relationships which reinforce fears of abandonment and feelings of worthlessness. Such situations can produce chronic negative feelings, worsened by their tendency for black and white extreme thinking and emotions. Due to this, being in a healthy long term relationship can sometimes help these people to recognise their fears as false and unhelpful thoughts.

Treatment:

Dialectical behaviour therapy (DBT) is a specialised therapy for emotion regulation. This is the main therapy given to clients with BPD. Due to its focus on teaching methods to calm extreme feelings and resist impulsive behaviours, it can help sufferers to combat the worst elements of their condition. Additionally, Psychotherapy or Cognitive behavioural therapy (CBT) can also be used to deal with emotional reactions to events in general. Furthermore, medication, such as antipsychotics, antidepressants, antianxiety or mood stabilizing drugs will sometimes be prescribed.

Some more high functioning sufferers may not have access to therapy as readily of others. unfortunately, our healthcare system is strained meaning a person may only have access to free therapy with a formal diagnosis on their record or following suicide attempts. In such cases, it’s useful to note the plethora of resources online. A great YouTube channel offering free therapeutic advice and information about BPD is the following: https://www.youtube.com/channel/UC932vfOwTbFni3GRrvVA6IQ

Co-morbidities

Depression, anxiety, substance abuse, other personality disorders, PTSD, Bi-polar