What is Borderline personality disorder (BPD)?
Borderline personality disorder is a mental illness that affects the way a person manages their emotions, self-image, and behavior. This has an impact on their daily functioning. It is a pervasive condition that comes about as a person’s personality develops and continues into their adulthood. Some of the presenting symptoms that characterize BPD are instability – in relationships (how they interact with others); in identity and self-image (how the person sees themselves or others); and mood (which tends to fluctuate often).
A person with BPD 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 often struggle with trying to fit in and can have severe insecurities with real or perceived abandonment in their interpersonal relationships. People with BPD can be very emotionally sensitive to what’s happening around them.
What causes BPD?
The exact cause for BPD is not known yet. A combination of biological, psychological and social factors determine the risk of a person developing it. Certain symptoms of this disorder are believed to be caused by an imbalance of serotonin in the brain. There is also evidence of improper brain functioning among people with BPD.
There are several environmental factors in a person’s developing years that have an impact on the likelihood of them having BPD in adulthood. Research shows that instances of abuse and neglect is common among people with BPD. Parenting has a significant impact on how a person views the world around them. Neglect from one or both parents where a child’s emotional needs were not met has been found to create a fear of abandonment in the latter. This carries over to their adulthood and is also a central characteristic of the disorder. Although not all children who are subjected to trauma are likely to develop BPD.
Over the last few years, there has been increased awareness in diagnosing it. This can be indicative of an increased prevalence. Globally, there is a visible gender disparity in who gets diagnosed with it - more women tend to be diagnosed. But men are also equally likely to have BPD. This disorder is not caused by a person’s gender. It is due to a combination of biological, psychological and social factors that are at play during the development of a person’s personality. There are many cultural elements that can lead to a person with BPD feeling invalidated. With changing time, as fluidity between and within genders and cultures increases, the gender disparity in BPD diagnosis is likely to decrease.
What are the symptoms of BPD?
BPD is characterized by maladaptive patterns of thoughts, emotions and behaviors. The most observable symptom is mood dysregulation where the person is unable to stabilize their mood in a given period of time. They are likely to interpret others’ words or actions as personal criticism or judgment which makes them sad or angry. Another is fearing rejection and abandonment.
Some of the other symptoms (which need to be present across situations in a person’s adult life for them to be diagnosed with BPD) are:
Unclear or shifting self-image: Confused identity can be seen in their values, behavior, friendships, sexual identity and career choices. People with BPD often struggle to answer the question, “What kind of a person are you?”
Unstable interpersonal relationships: People with BPD have a long standing pattern of unstable interpersonal relationships which also affects how they interact with others.
Fear of rejection or abandonment: BPD can make a person feel repeatedly misunderstood, rejected or empty. They feel afraid of being abandoned by their loved ones, and are willing to go to any lengths to ‘save’ a relationship.
Impulsive and self-destructive behavior: They are likely to give in to impulses and indulge in risky behavior such as reckless spending, substance use, or unsafe sexual activities.
Explosive anger: People with BPD have difficulty controlling their anger which can lead to frequent anger outbursts. This is expressed through shouting, throwing things, or physical altercations.
Feelings of emptiness: People with BPD very commonly feel hopeless and empty or a “void” among them. They strongly believe that they are not capable of coping with life on their own and need people around them.
Self-harming behavior or suicidal tendencies: Suicide among people with BPD is more common in comparison with the general population. Self-harm is also seen very frequently among them. Studies show that 65-80% of individuals with BPD engage in some form of self-harm.
Loss of touch with reality: Experiencing dissociation during stressful episodes; they may disconnect from events that cause them distress and have no memory of it later.
Note that for a diagnosis of BPD, five or more of these symptoms need to be present throughout the person’s adult life.These symptoms are indicative, do not arrive at any diagnosis based on these. The diagnosis of BPD must be done only by a trained mental health professional.
Treatment for BPD
It is treated with a combination of medication, therapy and support. In addition to medication, mental health professionals recommend that their clients with BPD access individual or group therapy. Medication is often prescribed to manage comorbid disorders like depression and anxiety.
People with BPD are at a higher risk of developing other comorbidities. These include - but are not limited to - mental illnesses such as post-traumatic stress disorder (PTSD), eating disorders, and obsessive-compulsive disorder (OCD). In such cases, treatment for BPD needs to be supported by treatment for any other related disorders the person may have.
Types of therapy that can help patients of BPD manage their disorder:
Cognitive behavioral therapy (CBT): The therapist helps the client change the core beliefs they have about themselves. Doing this can help the client manage their perception of self, and make it easier for them to relate to others. CBT helps in identifying a person's dysfunctional thought patterns and behaviors. Therapists work with clients, and help them learn or relearn skills and habits that are constructive. This in turn helps them face life situations in a rational way. The results of CBT are long-term, and a person can use their learning to resolve other problems in life.
Dialectical behavior therapy (DBT): DBT is a form of talk therapy that was modified from the existing practice of behavior therapy. The therapist tries to identify the thoughts or beliefs in the client that are causing problems, they are guided towards understanding and accepting themselves. DBT’s main aim is to help clients live a ‘life worth living’ by treating people who face difficulties in regulating emotions – it encourages them to solve their problems. It focuses on skills training to equip clients with the right tools to effectively cope with their issues. DBT also helps them create long-term goals and work towards it.
Mentalization based therapy (MBT): MBT is a form of talk therapy that encourages the client to narrate incidents from their own life. The therapist then helps the client validate their own thoughts and feelings. In doing so the client is made to identify negative extremes or generalizations in their ways of thinking. Called as non-mentalized modes of thinking, these could be thoughts like “I’m a complete failure, they always ignore me,” “Nobody in my life has ever loved me, I have always been rejected.” Targeted intervention by the therapist allows the client to see the incident from different perspectives. This allows the client to mentalize and self-regulate their emotions.Living with borderline personality disorder
If you think you have BPD, or if you have been diagnosed with it - don’t be disheartened. With the right treatment, medical care and the support of people around you can get the help you need. Here are some things you can do to help yourself:
Find a support system. Speak to a friend or family member you can trust and tell them about the diagnosis. You can ask them to accompany you to your next appointment with the doctor so that they can have a better understanding of the disorder.
Take the time to understand the symptoms you have and how it affects your daily functioning. Talk to mental health professionals who will give you accurate information; this will help understand your condition better.
Speak to your doctor to create a daily schedule. Keep yourself occupied through work, spend time doing things you enjoy.
Remember that the best way to cope with the disorder is to follow the prescribed treatment and take medication regularly.
If you visit a therapist, speak to them about your problems and try to — keeping in mind your comfort levels — not conceal any information. Therapy is supposed to be a safe and non-judgmental space for you and it’s important that you are able to speak freely.
Always keep in mind that your mood swings, the quality of your relationships does not define you, or make you a bad person. Having BPD is not something you can control, it is not your fault.
Caring for someone with BPD
Most people with BPD refuse to seek help if they are unable to see that their behavior is causing them, or the people around them distress. For the caregiver, this combination of distress and an unwillingness on the person’s part to change their behavior can be overwhelming. Most families that have a loved one living with BPD report experiencing feelings of stress, helplessness and frustration. This is compounded by frequently changing moods and behavior.
Caregivers might develop strong feelings of guilt about their loved one’s illness. BPD may be caused by childhood abuse or trauma, and the risk increases when a person is genetically related to someone who has had the disorder. This can make the parents feel ‘responsible’ for their child, causing them to desperately seek for a solution to ‘fix’ the condition.
Learn about the disorder: BPD is a much-maligned mental illness. There are several myths about it that are commonly believed: That people with BPD are manipulative; they pretend to be suicidal just for attention; and that they are very stubborn and don’t want to change their behavior.
As a caregiver, try to accept that you are not responsible for the condition, and that you cannot fix everything by yourself. What you can do is support your loved one, help them make decisions about their treatment and make sure that they follow the treatment plan devised. Try to be aware at all times that - it is a disorder that is making your loved one behave in a way that seems bizarre or unreasonable to you. Don’t take it personally, or as a sign of your failure as a parent/caregiver.
People with BPD have trouble adjusting to sudden changes; try not to make sudden changes in their schedule. If you know of a change that will happen soon or is going to happen inevitably, prepare them for it.
Setting boundaries: Most caregivers want to offer the maximum amount of support to their loved ones but don’t know where to draw the line. Some caregivers agree to everything their loved one wants or demands - this comes from not wanting to disappoint them. It’s important to learn to say no and have clearly defined boundaries.
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