Many of us have a fairly clear idea of who we are, and what characterizes us as individuals. This sense of “self” evolves through our early experiences and exposure to our environment, and we mostly develop them over the first two decades of our life. This understanding or sense of identity comes from what’s important to us, what we like and dislike, what we aspire for and where we belong at levels such as the interpersonal or societal (friends, work and our environment). For people who suffer from Borderline Personality Disorder (BPD), there are no consistent answers to these questions; the questions define their daily struggles.
Borderline personality disorder affects the way a person manages their emotions, and themselves. The most obvious characteristic of this disorder is instability – in relationships (how the person interacts with others), in identity and self-image (how the person see themselves or others) as well as mood (which tends to fluctuate often).
A person with borderline personality disorder does not have a fixed identity of “self” and attempts to define themselves by their current situation or environment. They may show contrasting personality traits or behaviour in different situations. They go through a constant struggle of desperately trying to fit in. They are extremely emotionally sensitive to what’s happening around them, and may react strongly even to simple, everyday events. Their behavior may make others see them as needy and attention-seeking.
Individuals who have borderline personality disorder show extreme emotions and behaviors in the face of everyday stress, and this causes distress and chaos in their internal and external worlds. This stress can make them have strong opinions about others and the situation, but mostly towards themselves. This makes them appear on the verge of major mental illnesses, giving this disorder the “borderline” tag.
The exact cause of borderline personality disorder is not known yet. However, we know that a combination of biological, psychological and social factors determine the risk of a person developing borderline personality disorder. Certain symptoms of this disorder are believed to be caused by an imbalance of serotonin in the brain.
A genetic predisposition to borderline personality disorder is that other personality disorders or mood disorders can put a person at a higher risk of developing borderline personality disorder.
Research has shown that abuse during childhood can make one vulnerable to developing personality disorder in adulthood. Some theories suggest that children who are abused grow up confused about how to process emotion, and therefore are confused about their own sense of self, or their reactions to events around them. However, not all children who are subjected to childhood trauma are likely to develop borderline personality disorder.
Borderline personality disorder is more commonly seen in women than men.
People with BPD have difficulty managing and controlling emotions. They may react with extreme anger or extreme happiness in situations to which others would mildly react. They have frequent mood swings, and may take decisions impulsively. They have difficulty in maintaining stable relationships due to their tendency to idolize people easily, and criticize them just as quickly.
As with all personality disorders, the various symptoms of BPD would be evident throughout an individual’s adult life span. Identifying a person with BPD can be tough and challenging due to the variety and intensity of symptoms. It is best to get a diagnosis from a trained medical professional to avoid any complications.
The most observable symptom of borderline personality disorder is the emotional upheaval; the person may react in extremes and have intense mood swings that last only a few hours. Their mood and behavior can be unpredictable and inconsistent. They are likely to interpret others’ words or actions as personal criticism or judgment, which makes them sad or angry, and fearful of being rejected.
Some of the other symptoms (which need to be present across situations in a person’s adult life) are:
There is no single test that can diagnose borderline personality disorder. The psychiatrist first conducts tests or assessments to rule out the possibility of other disorders such as schizophrenia, substance abuse, depression, eating disorders, anxiety disorders and other personality disorders, which may be contributing to the person’s behaviour. However, in some cases, these disorders may coexist with borderline personality disorder. The doctor may evaluate the person to rule out the possibility of these disorders contributing to the person’s behaviour.
The diagnosis is largely dependent on the interview conducted with the patient. The doctor also evaluates the person by asking questions that are related to the symptoms of borderline personality disorder. To be diagnosed as having borderline personality disorder, a person must exhibit at least five of the symptoms.
A person with borderline personality disorder may find it difficult to manage their relationships with friends, family and co-workers. This impacts their relationships, work and daily life. They are unable to maintain a job or relationship due to their extreme anxiety and intensely emotional reactions. They are likely to harm themselves by slitting their wrists, taking an overdose of drugs or alcohol, or committing suicide. They may also have to deal with mental health issues such as bipolar disorder, depression, anorexia or bulimia, and anxiety.
Borderline personality disorder is treated with a combination of medication, therapy and support. The doctor may prescribe mood regulators (to minimize mood swings) or anti-psychotic medication (to reduce delusions and hallucinations) to the patient. In addition, patients with this disorder are suggested to undergo therapy to help them deal with issues that make it difficult for them to manage their emotions or their relationships.
People with borderline personality disorder may also risk developing depression, anxiety disorders, PTSD, eating disorders, bipolar disorder and substance abuse. In such cases, the treatment for borderline personality disorder needs to be supported by treatment for any other related disorders the person may have.
Types of therapy that can help patients of borderline personality disorder manage their disorder:
Cognitive Behavioral Therapy: The therapist helps the patient to change the core beliefs they have about themselves. Changing these core beliefs can make the patient manage their perception of self, and make it easier for them to relate to others.
Dialectical Behavior Therapy: The therapist tries to identify the thoughts or beliefs in the patient that are causing problems. The therapist guides the patient into understanding and accepting themselves. After this step, the patient identifies the changes they would like to make in their life in order for it to improve.
If you think you have borderline personality disorder, or if you have been diagnosed it, don’t be disheartened. With medical care and support of your family and friends, you can lead a functional life. Here are some things you can do to help yourself:
Most patients of borderline personality disorder refuse to seek help because they are unable to see that their behavior is causing distress to them, as well as their friends and family. For the caregiver, the combination of distress and the patient’s unwillingness to change their behavior can be overwhelming.
Most families with borderline personality disorder patients report feeling stress, helplessness and frustration. They find it difficult to just watch when their loved one tries to harm or kill themselves. The distress caused by this experience is compounded by the patient’s behavior: patients may love their family at one moment, and in the next moment, may hate them intensely. The family may find it difficult to figure out where they stand and what their support and care means to the patient.
The caretakers might have strong feelings of guilt about their loved one’s disorder. Borderline personality disorder may be caused by childhood abuse or trauma, and the risk increases when the patient is genetically related to someone who has had the disorder. This makes parents feel ‘responsible’ for their child, and desperately seek solutions to ‘fix’ the condition.
Learn about the disorder: Borderline personality disorder is a much-maligned problem. There are several myths about this disorder that are commonly believed: that people with borderline personality disorder are manipulative; they are pretending to kill themselves just for attention; and that they are very stubborn and don’t want to change their behavior. It will help you relate to your loved one if you understand their struggle too.
As a caregiver, try to accept that you are not responsible for the condition, and you cannot fix everything by yourself. What you can do is support the patient take decisions about treatment and ensure that they adhere to the treatment plan. Try to be aware, at all times, of the fact that it is a disorder that is making your loved one behave in a way that seems bizarre or unreasonable to you. They may idolize you one day, and hate you the next – this is due to the ‘splitting’ that patients with borderline personlity disorder tend to do. Don’t take it personally, or as a sign of your failure.
Communicating with the patient can be challenging due to their mood instability. Be direct. Speak clearly and in short sentences, with no room for misinterpretations. Clarify if you think your point has not been understood accurately. Be authentic while speaking to the patient. Don’t try to flatter them to make them feel better. Try to find some aspect of their personality of behavior that you like or admire, and speak honestly about it. This will help their self-image, and will also help them understand that you care for them.
Try not to make sudden changes in the patient’s schedule. People with this disorder have trouble adjusting to sudden changes. If you know of a change that will happen soon, prepare the patient for it.
Setting boundaries: Most caregivers want to offer maximum support to their loved ones, but don’t know where to draw the line. Some caregivers agree with everything the patient wants or demands, because they fear that their refusal will drive the patient to self-harm. Learn to say no. Clearly define the boundaries. What activities and behavior will you be okay living with and adjusting to? Is aggression and violence acceptable? Check with your doctor about how you can handle a situation in which the patient gets physically violent. Keep yourself prepared for these situations.
Take care of yourself. Take some time out of your duty as a caregiver. Spend this time in an activity you enjoy. Make sure you keep in touch with your friends, and that you have someone you can speak to. Join a support group if there is one in your area. Most importantly, speak to your doctor or counselor when you are overwhelmed.