borderline personality disorder

What is Borderline Personality Disorder?

August 3, 2017 105 9 No Comments


Think of the last time you saw a “textbook case” of borderline personality disorder in a film or TV show. You’re maybe thinking of Girl, Interrupted (1999) or maybe even that one episode of Criminal Minds because how can they not have an episode depicting borderline personality disorder, right? 
Well, you’d be correct. Girl, Interrupted had the main character diagnosed with borderline personality disorder in the film at the age of 18, and Criminal Minds had an episode where a spree killer is depicted as having borderline personality disorder.

You’re also probably thinking of many other characters who seemingly show signs of borderline personality disorder. The problem is that Hollywood has a tendency to depict these characters with “borderline personality disorder” as vindictive, murderous, vengeful–pretty much descriptions of an antagonist.

But the truth is that in real life, people who suffer from borderline personality disorder are not antagonists. They are real life people who unfortunately suffer from a mental illness that has a bad rap.

Definition of a Personality Disorder
To understand what borderline personality disorder (BPD) is, you need to understand what makes it constitute as a personality disorder rather than, say a depressive disorder or a psychotic disorder.

There are 10 specific personality disorders as outlined in the Diagnostic and Statistical Manual of Mental Disorders, 5th ed. (DSM-V) one of which includes BPD. Each of these personality disorders are characterized by a pattern of “inner experience and behavior that deviates markedly from the expectations of the individual’s culture.” These deviations are unyielding, extensive, and overwhelming in a way that causes distress and impairment to the person with BPD, and often begins in the adolescent period or early adulthood.

Those ten disorders are then categorized into three groups: 
1. The first group have individuals showing signs of odd or eccentric behaviors.
2. The second group have individuals showing signs of dramatic, emotional or erratic behaviors.
3. The third group have individuals who show signs of excessive anxiety and fearfulness.

Take a guess which group borderline personality disorder falls under. If you guessed group two, you would be correct.

How to Diagnose Someone with Borderline Personality Disorder
First used in 1938 by Adolph Stern, “borderline” was the term used because patients with BPD were thought to “lie on the borderline between psychosis and neurosis.” Even with the first usage of the word being in the late 1930s, it wasn’t actually until 1980 that borderline personality disorder became a diagnosable disorder in the DSM-III–and from there BPD has stayed.

BPD is actually one of the most controversial diagnosis today in psychology even if the term has been used officially for over 30 years. The reason for this controversy is due to the uncertainties and inconsistencies in the current classification system.

Nowadays, even with the general consensus that there needs to be a change in the classification system, it is agreed amongst most psychiatric professionals that in order to be diagnosed with Borderline Personality Disorder, you would have to show signs of at least five or more of the following symptoms:

  • An intense fear of abandonment, and whether that fear is real or not, frantically trying to avoid separation or rejection
  • A pattern of unstable and intense interpersonal relationships, and showing extreme swings such as putting someone on a pedestal one moment then suddenly devaluing them the next. 
  • Persistent inability to focus on a sense of self, with rapid changes in self-identity and self-image
  • Impulsive behaviors that are risky and potentially self-damaging such as shopping sprees, gambling, unsafe sex, etc.
  • Continuous suicidal behavior which includes threats or gestures, as well as self-mutilating behaviors.
  • Intense mood swings and emotional instability that usually lasts a few hours, though sometimes do last a few days.
  • Continuous feelings of emptiness
  • Frequent displays of intense anger at inappropriate times and showing anger control problems.
  • Periods of paranoia due to stress, losing contact with reality and showing severe dissociative symptoms.

People with BPD can become very angry and even experience intense fear if they feel as though they are being abandoned. Unfortunately, their definition of abandonment can stem from something as unavoidable as when a clinician announces that their session is at its end.

Constant shifts from idealization and devaluation of others are common in those with BPD, where they would demand to spend lots of time together in the beginning before switching into believing that the other person does not care enough.

Think of the phrase “I hate you–don’t leave me.” This phrase can be used to describe the clinging and distancing behaviors that most commonly describe people who suffer from BPD. It is also the title of an aptly named book depicting BPD.

Fact, or Fiction?
Even with increased awareness in today’s age about BPD, there are still lingering myths and misconceptions about the disorder.

Myth: Only women have BPD.
 – Truth: It is true that a majority of those diagnosed with BPD are women, however men are also affected by the disorder. In fact, there are murmurings in the psychology circle that men may be just as likely to have BPD but are not encouraged to openly talk about their symptoms, thus remaining largely undiagnosed. Furthermore, it is possible that men experience and react to distress in a different way than women. Women tend to internalize their frustrations and anger leading to depression and self-mutilation tendencies whereas men may drink more and show instances of psychopathy. 

Myth: Those with BPD are just too hard to handle.
 – Truth: Those who suffer from BPD are genuinely suffering. Unfortunately, many people dismiss those with BPD as manipulative, destructive, and violent. Media portrayals of people with BPD show them as violent because of their strong tendencies towards intense anger, but a majority of researchers agree that they are unlikely to actually physically cause any harm towards others. Given the right treatment and therapy, people who suffer from BPD can learn to manage and regulate their emotions and behaviors in a way that can help them maintain relationships. At the same time, family and friends and loved ones can participate in support groups to help them better understand and communicate with someone who has BPD.

Myth: BPD is rare.
 – Truth: About 1.6% of the population show signs of BPD but the estimated number can actually be as high as 5.9%, with a majority of those diagnosed are females–a whopping estimated figure of 75%. Even with the average percentage of people who suffer from BPD being an estimated 2%, it accounts for more than half of the cases in a clinical setting. And of those who are psychiatric outpatients, 10% of them are diagnosed with BPD, while those who are psychiatric inpatients, 20% of them are diagnosed with BPD. 

Myth: Those who say they have BPD are really just attention seekers.
 – Truth: One of the symptoms of BPD is self-mutilation and suicidal threats, which many people often mistake as a way to seek attention. In truth, these self-destructive tendencies are used as a coping mechanism to self-soothe. When a person with BPD self-harms they usually do so in inconspicuous ways, easily being able to hide their cuts and scars under clothing. 

Myth: BPD is untreatable and there is no cure.
 – Truth: Treating patients with BPD is challenging and difficult especially with substantial risks such as inappropriate or insufficient treatment. However, while treatment may be difficult, it does not mean that there are no treatments. In fact, there are several treatment and therapeutic strategies that have been developed and researched over the years such as psychotherapy and dialectical behavior therapy.

Causes of Borderline Personality Disorder causes of borderline personality disorder
Just like any other mental disorder, there aren’t any true hard facts as to the causes of borderline personality disorder.

The most we can do is infer based on commonalities in the environmental factors such as a dysfunctional history during childhood. Those with borderline personality disorder often show commonalities in their childhood histories which include physical and sexual abuse, hostility, neglect, and early parental loss. There are also studies that suggest that genetics play a role. Personality disorders may be inherited, and are five times more common in those who are biologically related of the first-degree. Furthermore, there are possibilities that the dysfunction of certain brain chemicals that regulate emotions, impulsivity and aggression are causes of borderline personality disorder.

Is Borderline Personality Disorder Treatable?
Psychotherapy is the main leading treatment for those with BPD. With personalized touches for the treatments catered to each individual, psychotherapeutic strategies have shown large reductions in symptoms over time. The following are common treatments for people who are diagnosed with BPD:

  • Dialectical Behavior Therapy combines cognitive behavioral therapy with Eastern philosophy and traditions using the concept of mindfulness and environmental attentiveness.
  • Mentalization-based treatments focuses on the patient’s ability to mentalize and understand his/her and others’ mental states. 
  • Transference-focused psychotherapy focuses on the relationship between the patient and their therapists as well as the emotions that arises from that relationship. 
  • Cognitive Behavior Therapy has people with BPD focus internally, helping them identify and change beliefs and behaviors that are the roots of the symptoms.

If someone you know has BPD, the first and foremost important thing that you can do to help them is to get them to seek help. Getting the right diagnosis and the right treatment catered to them is essential for their treatment, and encouraging them to do so as well as continuing to encourage them to stay and receive treatment is the best thing that you can do.


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