Updated: Apr 1
These words often invoke an emotional response in people, as borderline personality disorder comes with stigmatizing images of unstable, unpredictable or even dangerous individuals. It's poorly characterized in the media, as Glen Close's character so illustrated in "Fatal Attraction". People who are diagnosed with it often feel they have been handed a form of social cancer, and feel frightened and powerless over something they feel they cannot control. Borderline personality disorder is probably one of the least well understood of all disorders, and people with it often feel hopeless. Personality disorders, after all, are often said to go as deep in a person as yellow is in a banana.
It is often mistaken by others for other disorders such as bipolar disorder, however personality disorders do not experience "highs" and "lows", they are constant; it effects the personality. It is characterized by history of unstable relationships, self-harming and chronic suicidal behaviors, fear of abandonment, impulsivity, dissociative symptoms, feelings of emptiness and poor sense of self, emotional dysregulation and "splitting", with is "black and white" thinking. They tend see others close to them in terms of all good or all bad and go into what is called "idealization/devaluation" mode. For example, they might meet a new friend and put them up on a pedestal, "nobody has ever understood me the way you do!" then, if they feel let down by them in some way, say they call and cancel dinner plans, they may turn and say, "You are lying to me. You were making up an excuse not to see me. I thought you really cared about me! You can't trust anyone, can you?" and abruptly terminate the relationship. They may call later, feeling remorseful about their actions, and leave the friend feeling like they are on a real roller coaster ride. The truth is, they do feel remorseful and they can't control their feelings or behavior if they haven't been given the tools to do that. BPD patients basically feel negative emotions stronger than the rest of us. That's it; their pain is real. It's been studied. People with BPD feel more pain, and feel it deeper, than any other disorder. This is crucial to understanding the behaviors that accompany this diagnosis.
I tend to be very, very careful with this diagnosis, as it is so heavily stigmatized. I think it tends to be exaggerated in it's prevalence as it is believed by many to stem from childhood trauma. There is somewhat of a controversial diagnosis of chronic, or complex post-traumatic stress disorder which mimics borderline personality disorder in many of it's characteristics and it is controversial as it is not defined in the DSM-5 and therefore has no reference point for diagnostic criteria, but many in the mental health field use it regularly to delineate PTSD from a singular event, as the DSM-5 has a more well-defined criteria for that, than from that stemming from repeated, long term trauma.
When I encounter someone with these symptoms, I tend to look for two criteria for borderline personality disorder: Self-harm behaviors and splitting. Splitting is the manifestation of fear of abandonment. In the mind of the person with borderline personality disorder, they must leave or be left.
There are all kinds of differentials for borderline personality. Those that are described above, as well as some clinicians believe that personality disorders tend to fall along a continuum of their cluster. Borderline personality falls into the B cluster, along with narcissistic and antisocial personality disorder: Disorders marked by a lack of perceived empathy, while individuals with borderline personality disorder suffer from a sort of "empathy fatigue" in which they are more sensitive to other's emotions, they are especially sensitive to negative emotions. Some people are said to have "borderline traits" and all this means is that they have four rather than five of the nine traits required for diagnosis in the DSM-5. Some clinicians don't believe borderline personality exists at all, that it's all a form of PTSD. I believe borderline personality exists, but that it is a multifactorial disorder, which means it comes from a combination of genetic and environmental traits.
So what's a person to do that has just been handed this diagnosis? They need a tool to help them navigate their emotions and express them in ways that are less self-destructive. This came in 1967, with the clinical psychologist, Marsha Linehan's, Dialectical Behavior Therapy. DBT is a variant of Cognitive Behavioral Therapy that is unique in that it gives the individual practical tools to help them navigate their difficult emotions, including "911 skills" that can be utilized in the moment of emotional crisis. Linehan developed this therapy to help her combat her own diagnosis. It also gives the sufferer insight to better anticipate when they are at risk for such a crisis, and tools to prevent such from occurring.
It would be incomplete and unproductive not to mention the positive side of borderline personality disorder, as I always do when I treat someone with it. None so well stated as below:
Resilience – Many people with BPD have battled struggles with drug and alcohol addictions, self-harm, suicidal behaviour, and eating disorders. Many are survivors of trauma and therefore the ability to manage the emotional dysregulations on a daily basis is nothing short of being warriors.
Empathy and compassion – People with BPD experience greater internal and external turmoil. However, this in turn allows for the ability to recognise and have greater insight for others in similar situations. Sharing stories of lived experience about emotional pain encourages others to open up and gives a sense of belonging and freedom from stigma. For instance, a study has shown that people with BPD are able to read facial expressions and emotions better than those without BPD.
Curiosity – Being extra sensitive and connection emotions, senses and surroundings allows for greater curiosity in the minds of those with BPD.
Bold – Impulsivity is a BPD trait that can be positively linked to being bold, courageous and having the ability to speak one’s mind.
Creative – The high intensity of emotions can be released into creative endeavours. Many people with BPD put their entire emotional expression into music, art, performance and writing.
Intuition – High sensitivity to surroundings learned from childhood means people with BPD are more aware of other people’s emotional states. Sometimes the intuition may be overwhelming but when managed, people with BPD can help others in distress rather than exacerbate the pain.
Passionate and emotional – When a person with BPD loves, the love is deep, highly committed and loyal to the relationship. Even though there may be struggles with attachment and fears of abandonment, these are ultimately manifestations of love. When the emotions are managed, liveliness and wittiness become the dominant qualities.
Protective – The care and intensity a person with BPD feels towards another person or situation may be translated into high aggression as a method of protecting others and the self.
I always mention to sufferers that Princess Diana was said to have had personality disorder, and she was one of the most revered women in modern history. Though many refute this as a stain on her legacy, it is widely embraced by people who suffer and see themselves in the good attributes she possessed.
It's a balancing act between embracing the good and working on the problematic. Always remember, it is the individual with borderline personality is the one truly suffering the effects of the disorder, and those who've recovered serve as a guiding light that there is hope at the end of this puzzling maze they walk through everyday. Perhaps reading this will help bridge the understanding gap about borderline personality disorder.