Borderline personality disorder (BPD) is a complex condition. It affects how a person feels about themselves and others. BPD is characterised by intense, unstable emotions and relationships as well as insecurity and self-doubt. BPD is misunderstood by many and it affects between 2-6% of Australians. Living with BPD is not easy and it can often be undiagnosed or misdiagnosed as Anxiety or Depression.
BPD makes everything about a person feel unstable, ranging from moods, thinking, behaviour, relationships, and sometimes identity. People with this condition have described BPD as the feeling of having an exposed nerve ending, essentially leaving someone to be easily triggered by small things. The causes of BPD are not yet clear, but research suggests that genetic, brain, environmental and social factors are likely to be involved.
Studies show that people with BPD have differences in the structural and functional parts in the brain, especially in the areas that control impulses and emotional regulation. However, more research is needed to understand the relationship between the brain and BPD.
Understanding The BPD Rollercoaster.
People with borderline personality disorder often feel a huge amount of emotional instability. It impacts a person’s self-image, likes and dislikes, and goals. This often makes them confused about their sense of self. The condition makes it difficult for a person to feel comfortable in their skin.
Many people with BPD act impulsively, have intense emotions, and experience dissociation (feeling disconnected to their bodies) and paranoia when most distressed. This emotional volatility can cause relationship turbulence. And the inability to self-soothe can lead to impulsive, reckless behaviour.
People with BPD are often on edge. They have high distress and anger levels, so they may be easily offended. They struggle with beliefs and thoughts about themselves and others, which can cause distress in many areas of their lives. People living with BPD often have an intense fear of instability and abandonment. As a result, they have problems being alone.
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BPD is also known for anger, mood swings, and impulsiveness. These qualities can discourage people from being around someone with BPD. On top of this, many people with the diagnosis struggle with self-awareness and how others perceive them. This makes them extremely sensitive. BPD is a mind and body condition. Its symptoms begin to manifest during the early teenage years and gradually improve during adult life.
Environment, Genetics, Brain Abnormalities.
Borderline Personality Disorder may be caused by genetics, brain abnormalities, and/or environmental factors. Early childhood adversity, such as child abuse or neglect, may be a factor. Some research suggests that BPD may be an inherited genetic condition or linked with other mental disorders among other family members. And certain brain differences are thought to be contributing causes of the disorder. When the brain chemicals responsible for mood regulation don’t function properly, there are changes in some areas of the brain. This has been linked to aggression, difficulty regulating destructive urges, and depression.
Borderline Personality Disorder Myths & Misconceptions
BPD is misunderstood by many, including some mental health practitioners. This confusion can impact and influence the way that people are treated. Even worse, long-standing myths can discourage people from seeking help for the condition, especially if they feel their experience is being misunderstood.
Some common myths and misconceptions are:
It’s Not Treatable
Borderline personality disorder is very treatable. In the past, since BPD affects someone’s personality, professionals were quick to conclude that it was untreatable because someone’s personality cannot be changed. This theory has since been proven false.
More recently, many therapies have been proven effective as treatments, including:
Dialectical behaviour therapy (DBT)
mentalisation-based treatment (MBT)
Transference-focused psychotherapy (TFP).
Time Line Therapy® (TLT)
Now, a growing number of less intensive, generalist approaches, like general psychiatric management (GPM), are also being practiced around the world for BPD. A diagnosis doesn’t mean that someone will live with symptoms forever. With treatment, the symptoms can ebb and flow and many people with the condition can have high-functioning lives.
People With BPD Are Victims of Child Abuse
This is not always the case. While some cases of borderline personality disorder stem from childhood trauma, a diagnosis is more likely to be the result of a combination of environmental factors. These can include attachment, childhood trauma, biological factors, and social factors.
It Affects Only Women
It’s estimated that over 14 million Americans and 2-6% of Australians have BDP. Once more commonly diagnosed in women, the largest study done on psychiatric disorders shows that it occurs equally often in women and men.
One explanation behind it appearing to affect more women is that women are more likely to seek mental health care than men. Since research on BPD is often conducted in a psychiatric setting, it was previously less likely for men with borderline personality disorder to be included in these research efforts. Another explanation is that BPD is often misdiagnosed in men. Many men with the condition are often diagnosed with depression or PTSD.
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Awareness Of BPD In Self & Others
People with borderline personality disorder struggle with self-regulation. Self-regulation is the ability to manage emotions, thoughts, and behaviours in ways that have positive outcomes, like self-esteem and good relationships. To be officially diagnosed, a person has to exhibit five or more related symptoms. These symptoms have to be ongoing and impact various aspects of life.
There are a handful of medically recognised symptoms of borderline personality disorder, which are:
Instability in Relationships
Intense and short-lived relationships are common for people with BPD. It’s very common for someone with this diagnosis to have intense, unstable relationships filled with drastic and quick-changing feelings.
A person with BPD may fall in love quickly and assume that the other person will make them happy. Typically, this results in the person feeling hurt and disappointed and can further intensify emotional swings. People with this condition may have either perfect or horrible relationships, with rapid changes in perception resulting from anger, hate, and devaluation.
Extreme Emotional Swings
Someone with this condition often experiences unstable moods and emotions. The little things that don’t mean much to others like; someone not holding the door open for you or meeting a new friend – can be either very exciting or frustrating.
People with this diagnosis can be happy one moment and extremely sad or disappointed the next. Their moods are also very intense and unpredictable in timing. They can last anywhere from a few minutes to a few hours or longer.
Explosive Feelings of Anger
Many people with BPD struggle with intense anger and a short temper. This makes it difficult for them to feel in control of their emotions once they have been provoked. They can quickly fill with rage, though this anger may not always be outwardly directed and can result in self-harm. Sometimes the person might be angry at themselves and not at anyone or anything else.
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Self-harm is risky behaviour that may make the person feel good at the moment of distress. Many people with BPD often engage in self-harming activities, think about suicide, and make suicidal gestures and threats. Many people with borderline personality disorder engage in sensation-seeking behaviour that could be harmful, especially when they are angry.
Risky or deliberate self-harm activities may include:
- Engaging in dangerous and unhealthy binge drinking
- Cutting or other self-injury
- Going on shopping and spending sprees
- Regularly engaging in unsafe sex
- Binge eating or not eating at all
- Using drugs
Not all self-harm is intended to end in death. It’s important to remember that it’s often used as a way to feel better in a grim moment. However, if it goes untreated, these risky behaviors can end in suicide.
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Lingering Feelings of Emptiness or Worthlessness
A lot of people diagnosed with BPD struggle with feelings of emptiness or worthlessness. Many report feeling like there is a void inside of them or like they don’t matter. As a result, they often turn to sex, drugs, or food to try to feel satisfied.
Feeling Out of Touch With Reality
Many diagnosed with BPD feel suspicious about events in their lives. They struggle with feelings of suspicion and paranoia about the intentions of people around them. When they are stressed, they may lose touch with reality and become disassociated. Disassociation feels like being spaced out, foggy, or as if you exist outside of your own body.
BPD can be confused with other forms of mental illness, so a diagnosis is important. If you or someone close to you often has feelings of emptiness, loneliness, or insecurity that cause irrationality or impulsivity, it’s important to talk to your health care provider.
When Is It time To Seek Professional Help?
If you are experiencing any of the previously mentioned signs and symptoms associated with borderline personality disorder, please consult a mental health professional. This condition is common and treatable. If you are unsure of your triggers, try to think of a time in the past when you experienced raging and intense emotions, acted impulsively, or had a desire to harm yourself. The events before this emotion are likely your triggers.
Many who have BPD experience suicidal thoughts. These can include but aren’t limited to mental images and fantasies about self-harm and plotting to commit suicide. If you are experiencing suicidal thoughts and may harm yourself or someone else, call 000 immediately or visit your nearest medical facility.
Understanding and Recognising Symptoms
People with BPD are sensitive to stress, so stressful situations activate symptoms related to BPD. The stressors that promote BPD’s most volatile symptoms can be external or internal, and they often vary from one person to another. There are both interpersonal and mental triggers of borderline personality disorder, many of which are unique to the individual.
Managing these symptoms, either for yourself or your partner, starts by understanding emotions, thoughts, and memories that set off symptoms. Then you can better manage addressing the symptoms if a stressor is unavoidable. You should work with a mental health professional to learn physical and mental exercises to understand triggers and develop skills to successfully manage them.
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Separations, disagreements, and rejections – real or perceived – are the most common triggers for symptoms. A person with BPD is highly sensitive to abandonment and being alone, which brings about intense feelings of anger, fear, suicidal thoughts, self-harm, and very impulsive decisions.
When something happens in a relationship that makes them feel abandoned, criticised, or rejected, their symptoms are expressed. People with borderline personality disorder experience rejection sensitivity, which makes relationships very intense and dependent. Events that can worsen this can be losing a job, ending a relationship, or experiencing rejection of any type.
To better manage triggers, it is crucial to understand episodes. These episodes are highly dependent on the situation at hand and the specific individual, but there are common red flags for recognising an episode.
Things that can indicate an episode is occurring:
- Intense angry outbursts
- Suicidal thoughts and self-harm behaviour
- Going to great lengths to feel something, then becoming increasingly avoidant and withdrawn
- Paranoia, feeling as if there is someone out to get you
These episodes can also involve extreme feelings of positivity and euphoria. People with BPD can be very impulsive. It’s important to note these emotional highs as signs of an episode because they may be involved in risky behaviour as well.
Professionally Treating Borderline Personality Disorder
Treatment involves breaking down the dysfunctional patterns of the brain’s thinking, feeling, and behaviour that cause distress. So one can maintain better emotional balance. Sometimes health care providers may suggest medication as part of a care plan. However, never take medication without a therapy plan.
The treatment options often used are general psychiatric management (GPM), dialectical behaviour therapy (DBT), mentalisation-based treatment (MBT), and transference-focused psychotherapy (TFP).
General Psychiatric Management
Sometimes referred to as good psychiatric management, GPM is designed to provide “good enough” treatment to most patients. This treatment is not inferior to others. Studies have shown that GPM can be as effective as DBT in treating patients. GPM combines the essential ingredients of other treatments to provide care to the patient, even when specialised or more resource-intensive treatments are not available.
Dialectical Behaviour Therapy
DBT is known as the gold standard BPD treatment. It emphasises the development of four skill sets: mindfulness, interpersonal effectiveness, emotion regulation, and distress tolerance. DBT teaches patients to control their intense emotions and minimise their destructive patterns. Through DBT, patients can also learn how to build interpersonal skills and develop self-awareness. DBT has been clinically tested, proven to be effective in borderline personality disorder and depression treatment in adolescents and adults.
MBT aims to help patients by improving interpersonal and relationship skills while reducing self-destructive behaviours. Mentalising focuses on the ability to differentiate and concentrate on your emotional state of mind and separate your own thoughts and feelings from those around you. Since individuals with BPD can find it difficult to recognise the impacts of their behaviours. MBT encourages focusing and reflecting on mental states to better understand how mental state affects behaviour in ourselves and others.
TFP focuses on the patient’s sense of identity and aims to create more stable and realistic experiences of both self and others. With BPD, one’s sense of identity may feel contradicted. TFP focuses on addressing identity-based problems with interpersonal relationships, self-esteem, and mood.
By helping patients learn to verbalise what they are feeling, versus acting impulsively on emotions, TFP helps with increased functioning and satisfaction in interpersonal relationships. In addition to these therapies, group and individual therapy may be useful. Group and individual therapies cover a broad range of topics and are not necessarily sessions dedicated to BPD. Group and individual therapy can be beneficial for addressing mindfulness, interpersonal relationships, stress management, emotion regulation, and family relationships.
How Is Borderline Personality Disorder Diagnosed?
Borderline personality disorder is a complex condition that doesn’t present itself the same way in every person. Some mental and psychological disorders have similar symptoms, so it’s vital to see a licensed mental health professional for an assessment and the right diagnosis.
To diagnose, your provider may go through the following:
- A detailed interview with your doctor, a mental health provider, or both
- A psychological evaluation
- Medical history and/or a medical exam
- Discussing signs and symptoms, including criteria and signs of BPD
Most diagnoses are in patients 18 and older. BPD can, however, be diagnosed in younger patients. If you are experiencing the mentioned signs and symptoms associated with borderline personality disorder, please consult a mental health professional. People with this condition often experience suicidal thoughts, such as mental images and fantasies about self-harm and plotting to commit suicide. You should contact a suicide hotline number, a close loved one, or a mental health provider to get help.
BPD Is Not For Life
Because borderline personality disorder is as unique as each person who lives with it, treatment requires a specialised approach. Many people have BPD at times, experience emotional anguish from the diagnosis. However, you don’t have to resort to living a life that’s full of pain and heartbreak. It’s important to take care of yourself, recognise your triggers, and work with your health care team to determine what treatments will help keep it in check. By committing to care and learning as much as possible about it, you can make a difference in your quality of life and the lives of those around you.