As of late, there seems to be a bit more media coverage of Borderline Personality Disorder, whether it’s due to popular celebrities or Dr. Drew’s recent blurbs on CNN. I am writing this blog for anyone who wants to learn more about BPD, and I want to provide the facts and debunk the myths and rumors.
Borderline Personality Disorder, according to the DSM-IV-TR, is a psychiatric condition that can be summarized with nine symptoms. Keep in mind that BPD is along a wide spectrum—-some individuals may simply have features of BPD, whereas other individuals may have the full constellation of symptoms and present at the more severe end of the disorder. Also be mindful that a personality disorder means that the individual has pervasive and consistent traits that interfere with their daily functioning, and almost always cause significant interpersonal problems. This being said, the symptoms of BPD are as follows:
1) Frantic efforts to avoid real or imagined abandonment
2) Unstable and intense interpersonal relationships
3) Lack of a clear sense of identity
4) Impulsiveness in potentially self-damaging behaviors, such as substance abuse, sex, shoplifting, reckless driving, binge eating, etc.
5) Recurrent suicidal threats or gestures, or self-mutilating behaviors
6) Severe mood shifts and extreme reactivity to situational stresses
7) Chronic feelings of emptiness
8) Frequent and inappropriate displays of anger
9) Transient, stress-related feelings of unreality or paranoia
These nine symptoms can be grouped into four primary areas:
1) Mood instability
2) Impulsivity and dangerous uncontrolled behavior
3) Interpersonal dysfunction
4) Distortions of thought and perception
In light of these aforementioned symptoms, I feel it’s important to point out strengths and positive characteristics that are also very common for people suffering from BPD. People with this condition are usually highly intelligent, very bright and very skilled at reading other people. They are quite good at noticing and detecting other people’s subtle cues that are overlooked by many. Famous people who have been speculated to have suffered from BPD are: Marilyn Monroe, Thomas Wolfe, Princess Diana and Zelda Fitzgerald.
So what does it feel like to have BPD? It is a life full of unpredictable anguish, of being on a wild roller coaster over which the passenger has no control of its speed or course. It is painful to live in the skin of someone suffering with BPD partly due to the chronic sense of emptiness. The loved ones of a person with BPD may feel as though they never know who the person will be on any given day—and, due to the chronic sense of emptiness and lack of stable identity, the person with BPD does not know who they are on any given day, either. Another problem that both a person with BPD and his loved ones experience is the difficulty with “black or white” thinking. A person with BPD tends to see things as “all or nothing”—either a person or situation is “all good” or “all bad.” This leaves no room for the gray area that lives within all human beings, and is true of almost all situations in life. Due to the inner turmoil of someone with BPD, one person can be “all bad” one day, where they are the recipient of an intense rage, and that same person can be “all good” a day later, where they can do no wrong. This, understandably, is an exhausting experience for both the recipient and the person with BPD.
So how does this condition develop in an individual? It is very common, though not a criteria, for individuals with BPD to have a trauma history. One theory is that individuals who struggle with BPD are born with a highly sensitive temperment. Though this can be an asset (e.g., highly sensitive individuals are usually very skilled at reading interpersonal cues) a person with a very sensitive temperment needs to be raised in a highly conscientious manner. A person like this experiences feelings very intensely, and if he is not taught appropriate ways to modulate these overwhelming emotions, this person’s inner life can feel like an ongoing series of wild storms that leave him drowning. If a person like this grows up in an invalidating or abusive environment, or experiences trauma, an already intense inner life becomes that much more overwhelming and difficult to cope with. If the person does not learn appropriate and healthy ways to deal with these emotions, and is traumatized or severely mishandled to boot, he may resort to unhealthy coping mechanisms that may appear self-destructive and extreme to an outsider (e.g., like substance abuse or binge eating) but may seem to him like the only way to deal with the intense inner pain.
This post only covers this incredibly complex condition with very broad brushstrokes, but keep in mind that it usually takes many years for someone with BPD to be accurately diagnosed. This is because BPD has a lot of overlap with other conditions. Common misdiagnoses are: bipolar disorder, attention deficit disorder, depression, anxiety disorder, eating disorder, obsessive compulsive disorder and post traumatic stress disorder. As such, it is also very common for someone with BPD to be in an out of inpatient and outpatient treatment, and to have a history of meeting with a string of multiple therapists. They may also have the experience of being “handed off” by different health providers simply because the provider didn’t know what to do or was fed up, or the BPD person may have ended therapy themselves.
The good news is, there is hope for someone with BPD. There are treatment modalities that have been shown to be quite effective for individuals with this affliction, such as Dialectical Behavioral Therapy, and there are some psychiatric medications that can help make some of the symptoms more manageable.
If you are interested in learning more about this condition, I would highly recommend the following books to get started:
1) “I Hate You, Don’t Leave Me: Understanding the Borderline Personality” by Kreisman Straus
2) “Stop Walking on Eggshells: Taking your Life Back when Someone you Care About has Borderline Personality Disorder” by Mason and Krager
If you think you or someone you love may suffer from this condition, please know there is help. One way to begin the journey of understanding and healing is to contact Dr. Anne Perry or Dr. Jonah Lakin for an initial consultation appointment. Please see the home page for more information.
I have a very collaborative and interpersonal style, and consider the work of therapy as a journey to walk alongside you. I believe the purpose of therapy is to enhance your internal wisdom so you can operate in a more full and authentic fashion, and to help focus on making satisfying and meaningful choices.