Borderline Personality Disorder
Do you have BPD? What is BPD? How is it treated? This article takes an in-depth look at Borderline Personality Disorder.
By Jourdan Travers, LCSW | August 1, 2021
Hi everyone! Here, I'm shifting my focus to describe and explain more about specific mental health diagnoses and providing psychoeducation around those disorders. I couldn't think of a better diagnosis to start with than Borderline Personality Disorder, or BPD.
As humans, we all have different ways of thinking, feeling, and behaving. Some of us identify as more pragmatic and methodical, whereas others lean more towards passionate and emotional responses. This doesn't mean there's anything wrong with you. They're just differences, and they're what makes up our personality. And, while we can all respond rationally or emotionally depending on the circumstances, many of us have trouble regulating our emotional responses. Everything feels unstable in our relationships, moods, behaviors, thoughts, and even our identity.
We feel like we're on a rollercoaster, continually moving up and down. And, when you're in the throes of overwhelming emotions, it's hard to think straight or stay grounded. You may say hurtful things or act out in dangerous or inappropriate ways that make you feel guilty or ashamed afterward. When these traits start to become the norm versus an occasional occurrence, you may be diagnosed with Borderline Personality Disorder, or BPD.
I'm going to talk about BPD: what it is, what it's not, and help reduce some of the shame and stigma surrounding this diagnosis.
What is BPD?
BPD, like many diagnoses, isn't a one size fits label. Many of us have different symptoms and have a history of self-medicating with drugs, alcohol, and/or self-harming behaviors. As a therapist, some of the things we look out for to assess whether someone meets the criteria for BPD include patients saying:
- "I feel nothing."
- "One minute I'm happy and excited, and the next I'm angry, upset, and sad and I don't know why or how to control it."
- "I'm afraid my partner is going to leave me and find someone else and that I'll be alone for the rest of my life."
- "I struggle to have healthy relationships with others."
- "I often do things at the moment that I know isn't good for me (i.e., having unsafe sex, driving recklessly, using drugs and alcohol, and going on spending sprees.)"
- "I have a history of self-harming (cutting, burning, etc.), threatening and attempting suicide when I feel emotionally unstable."
- "When I'm feeling insecure in a relationship, I will lash out to keep my partner from leaving."
Suppose several of these statements (3 or more) feel applicable to you. In that case, it might be time for you to talk to a mental health professional to see if you meet the BPD criteria and engage in psychotherapy or another behavioral intervention such as Dialectical Behavioral Therapy (DBT).
Causes of Borderline Personality Disorder
You might be wondering, what causes BPD? The truth is, a variety of factors, including genetics, brain development, and environmental factors, such as:
- Being a victim of abuse
- Experiencing high rates of instability throughout childhood
- Being neglected by one or both of your parents/caregivers
- Growing up with family member(s) who had a severe mental health condition or battled with addiction
It's important to note that while BPD can be challenging to treat, it's not impossible, and BPD is not a form of Bipolar Disorder.
Many patients state they believe they have Bipolar Disorder because their mood is constantly changing, but here's the thing: Bipolar Disorder is different from BPD in that mood swings aren't changing within the hour or day. Bipolar Disorder is characterized by mania, which lasts days, not hours.
Types of BPD
The reason why it's so important to work with a mental health professional if you're experiencing these emotions is that there are different types of BPD, and no two people with BPD have the same emotional experiences. The four main types of BPD that mental health practitioners pay attention to (first identified by American psychologist Theodore Milton) are:
- Quiet "discouraged" BPD, often known as "high-functioning BPD," characterized by having intense, internal mood swings that no one else can see. Other examples of quiet BPD include:
- Withdrawing when you feel upset.
- Avoiding communication with those who've upset you and cutting them from your life entirely.
- Blaming yourself whenever there's a conflict.
- Fear of being alone, yet pushing others away at the same time.
- Difficulty building friendships and connections with others.
- Impulsive BPD, which is often mistaken or misdiagnosed as Histrionic Personality Disorder, looks like:
- Engaging in sexually suggestive behaviors with others without even realizing it
- Keeping relationships on a surface level instead of developing deep and strong bonds with others
- Acting on thrill-seeking behavior urges without considering possible consequences
- Manipulating others to be the center of attention
- Petulant BPD is marked by fluctuations of explosive outbursts and feelings of unworthiness and is often seen as willful, defiant, and unwilling to admit when they're wrong. Other symptoms include:
- Trouble identifying and expressing feelings
- Giving partners and loved ones ultimatums
- Making others feel guilty when they don't do exactly what you want them to do
- Using intimidation to keep partners from leaving you
- Self-Destructive BPD. This subtype is pretty self-explanatory in that individuals in this category are their own worst enemies. Most notably, they tend to:
- Sabotage themselves when things are going well or are starting to improve
- Lack a stable sense of self
- They are characterized by not expressing and, instead, internalizing emotions such as anger and sadness.
- Difficulty acknowledging and expressing desires
You might be wondering, what is BPD therapy, and how is it treated? There are several different types of treatments, with DBT topping the list as the most studied and the most effective. Dr. Marsha Linehan created DBT, and it works by helping those with BPD practice mindfulness and paying attention to the present moment. It teaches skills to control intense emotional waves, decrease self-harming behaviors, and to help with acceptance and change. It's a proactive and problem-solving approach with patients engaging in weekly individual therapy sessions, skills training group sessions, and phone coaching as needed.
I want to highlight here that there is no medicinal treatment for managing BPD symptoms because medications in and of themselves cannot cure BPD. Still, they are often prescribed for patients suffering from BPD to treat other conditions, including anxiety, depression, and impulsivity, often associated with the diagnosis.
Because one of the primary treatment goals in managing BPD is learning proper self-care, doing things such as exercising, creating a sleep routine, maintaining a nutritious diet, and learning healthy stress management coping skills to help reduce mood changes and irritability. These are all important aspects of a BPD therapy plan.
Living with BPD isn't a death sentence. There is hope. Many people living with BPD are high-functioning individuals. Research has shown that BPD symptoms decrease in severity and intensity with age and that BPD can go into remission, which means that your symptoms stabilize over time. The goal is learning how to manage your emotions and learning how to respond versus reacting to what is happening around you. Talk therapy is the best place to start if you feel you are facing some of these challenges.