Borderline Personality Disorder
BPD consists of a number of symptoms including: chronic feelings of emptiness, dissociative symptoms, impulsivity, rapid mood swings, low self-esteem, instability in goals and self-identity, instability in relationships, anxiety, anger, fear of abandonment, and suicide attempts and self-harm. It is often misdiagnosed as bipolar at first because of the similarities in depressive episodes and the severity of mood swings, although it is possible to have both disorders. About 80% of people with BPD will attempt suicide at least once in their life time. About 12% of those will succeed, making BPD the most life-threatening mental disorder after eating disorders.
There is no known cause for BPD, but there are theories. Many professionals believe it is a combination of nature and nurture. Most people with BPD have a family history of either BPD or other mental illnesses (such as bipolar), although it is also possible to have BPD despite having no family history of mental illness. Ultimately, it’s decided that someone with BPD always had a brain which had the potential to develop the disorder, but an event later in life triggered the symptoms, such as a trauma, although a trauma does not have to occur in order for BPD to develop. Many people with the disorder claim to have experienced symptoms at an early age, although the diagnosis is normally not made until one is 18 or older. BPD does not really make its presence known until later development because of the part of the brain it affects, but diagnoses can still be made in minors.
Many people with BPD come from abusive upbringings or suffered some form of abuse or trauma in their adolescence or adulthood. Most of them are also diagnosed with PTSD. Other common comorbid disorders include bipolar disorder, depressive disorders, anxiety disorders, and other personality disorders. BPD affects an estimated 2-6% of the population.
“People with BPD are violent.”
People with BPD are angry, certainly, but they are far more likely to be a danger to themselves than to anyone else. A loved one with borderline is more likely to lash out against themselves. Any damage they cause is probably going to be self-inflicted. This isn’t to say there aren’t borderline abusers. Abusers are everywhere! But someone with BPD is probably only a danger to themselves. They may self-harm, engage in dangerous activities, abuse substances, or even commit suicide.
“People with BPD are abusive.”
According to studies by Lundy Bancroft, people with severe mental illnesses are less likely to be abusers than people who are not mentally ill. Abuse is often planned and calculated, which is easier to do when one has a healthy mind. Many studies show that mentally ill people are far more likely to BE abused than they are to be abusers themselves. The stigma that people with certain disorders are abusive actually leads to their being abused more often. Because of mental illness, they are already more vulnerable to manipulation and gaslighting from any potential abuser, and an abuser will use stigma against them to make them comply to demands. Someone with a stigmatized mental illness is far less likely to leave an abusive situation because people are less willing to help them as well.
"People with BPD are attention-seeking and manipulative.”
First thing’s first, wanting attention is a pretty human reaction. Seeking attention is also something everyone does as some point, even those who are not mentally ill. (You just tend to pathologize it when mentally ill people do it.) Second, everyone manipulates and is capable of doing it. Having a disorder of any kind does not default someone into a manipulative type of person. The truth is, people with BPD are not trying to manipulate you when they come to you about their feelings. Their expression is not some clever ploy. If they cry, they truly are hurting and not looking for pity. If they say they need constant reassurance, it’s because they are genuinely afraid.
“People with BPD could control their emotions if they tried.”
Yeah, and when I had the flu a couple of months ago, I simply willed it away. [/sarcasm] The truth is, BPD is a serious medical condition which affects the brain. You know that part of your brain that helps you regulate your emotions? (It’s located in the front of your brain.) Well, for people with BPD, that part of the brain doesn’t work as well as everyone else’s. Marsha Linehan compares people with BPD to third-degree burn victims, saying that every touch is something they feel immensely. I don’t personally like comparing mental health conditions to physical ones, but nonetheless.
“People with BPD are self-centered.”
More often than not, the opposite is true. A lot of the pain and anxiety someone with BPD feels stems from insecurities they have about how they affect the people around them. People with BPD tend to assume they are burdens and constantly worry they are making people unhappy, which upsets them and can trigger an episode. If anything, people with BPD care too much.
I love someone with BPD. What can I do to help?
- People with BPD are incredibly perceptive and can read most emotions, but one emotion they consistently misinterpret is anger. They tend to interpret neutrality as anger, so often they may assume you are angry when you are simply content or bored or some other neutral expression. If your borderline loved one asks if you are angry, try to be patient and remember they are hypersensitive to tone, body language, everything. When an emotion of yours can’t be pinpointed, they tend to assume it’s anger. “Are you mad at me?” may be something you hear incredibly often. Just answer the question and be patient. They don’t mean to sound like a broken record; they really do believe you’re mad at them!
- When providing reassurance for a borderline loved one, be sure to use concrete examples. When they’re having an episode, saying, “You’re a good person” will feel like empty words to them. They may even assume you’re following a script. Even more likely, they will default to being afraid they’ve somehow manipulated you into saying nice things to them, so be sure to have examples to back up what you’re saying. Instead of “You’re a good person,” add on why you feel that way about them. “You were having a bad day last week, and you still dropped everything to support your friend when they needed you.” Instead of stopping at, “I really care about you and think you’re great,” be sure to add, “You’re an incredibly passionate person, and I find that inspiring. Yesterday, when you were working, you become really involved in the task and cared a lot about the end results, and the way you poured your passion into the task was really incredible.”
- Express yourself often, and in a constructive way. If you aren’t upfront with your feelings, your borderline loved one may assume you hate them. Open communication is incredibly important. If you are upset with something they’ve done or said, be sure to bring it up in a constructive manner which helps both parties and encourages communication on both ends. (Actually, you should be doing this with non-borderline people too.) Compassion > hostility. It’s okay to be upset, but it’s no reason to lash out. Bring up your concerns as soon as possible and help build an environment where you can both talk about these things openly. A relationship where you feel you can’t talk about concerns isn’t a healthy one. That goes for all relationships, mental illness or no.
- Also applies to all relationships, if your loved one is clearly distressed, sometimes it’s best to walk away and wait until everyone has calmed down. However, with a borderline loved one, it’s important to express what you are doing and why. Don’t just leave the room. Make it clear, “We’re both too emotional right now to deal with this. I suggest we take a break and come back to this in half an hour when we’re feeling calmer. Is that okay with you?”
- Do not try “tough love.” It is grossly unhelpful and can actually trigger more severe symptoms and make them worse. “Tough love” is a surefire way to keep your loved one from recovering.
- Because of how emotional they are, people with BPD can come across as self-centered. This usually isn’t true, and is in fact more often the opposite. People with BPD are constantly thinking of the needs of others, and often their emotional responses are because of anxiety they have about how they affect the people around them.
- Do not invalidate the feelings of your borderline loved one. Recognize that even if these feelings are not fact, they are still valid and are hurting your loved one and are incredibly real to them. Do not tell them they are “crazy” or “delusional.” This will make them feel like they can’t open up to you. Instead, assure them their feelings are valid, and then work through those feelings. Instead of, “There’s no need for you to feel guilty,” try “I understand why you feel guilty, but remember you are not at fault for what happened.” Or let’s say your borderline loved one has accused you of being angry even though you are not, and they are upset. Instead of “You’re upset for no reason” try “You are rightfully upset, however I’m really not angry with you, so let’s try to help you feel better.”
Relationships and BPD
Maintaining relationships (romantic, platonic or otherwise) can be difficult for anyone. For those with BPD it can be an ongoing struggle. We suffer from a range of symptoms that seem to constantly work against the idea. These symptoms can affect our ability to keep healthy and happy relationships.
Some of the symptoms that may affect our ability to maintain relationships are (but not limited to):
- Splitting (also known as idealizing/devaluing, black/white thinking, and all/nothing thinking): We often have trouble seeing the ‘middle ground’ in situations, and so instead we label things as either ‘all good’ or ‘all bad’. We do this in our relationships as well. One minute we may love someone and the next we think we hate them. We sometimes even split within ourselves. When we’re doing well, we believe we’re “good” people and worthy of love and affection. When we experience feelings of shame, we may instead believe we’re “bad” people and deserve for awful things to happen to us. This can deeply affect our relationships. If we’re in a state of mind where we don’t believe we deserve love, we’re less likely to accept it. This can make a relationship chaotic and unstable due to the constant pushing and pulling.
- Inappropriate anger/difficulty controlling anger: Some people with BPD experience intense anger. This anger can be experienced in different ways. Some sufferers may draw their anger inward and feel deep shame, blaming themselves for almost everything. Other sufferers may project that anger outward, expressing that the fault is on other people. There are also sufferers exhibiting this symptom who experience a bit of both. Sometimes their anger is internalized, other times it’s externalized. The inability to properly examine and express anger can severely damage the health of a relationship.
- Frantic efforts to avoid real or perceived abandonment: For those of us who struggle with this symptom, the fear of abandonment can lead to extreme behaviors. These behaviors may eventually push the other person away. Because of a fear of abandonment, some sufferers also believe that it is safer to leave before they can be left.
Meaningful relationships are an important part of life. This brings me to the next point: the stigma surrounding BPD is quite harmful. Many people have gone as far as to say that a relationship with BPD sufferers is downright impossible. This is very untrue and, quite ironically, a very black and white way of thinking. A relationship with a person who has BPD is likely to require more patience, understanding, and communication (from everyone involved) than a typical relationship, but it’s very much possible. In fact, a relationship with a sufferer can be very rewarding, as many of us are known to express deep empathy and compassion. It all comes down to whether or not you’re compatible and the amount of work the person on both sides of the relationship is willing to put in.
There are a few things that are important in keeping a relationship healthy:
- Communication: This is a priority in any relationship. It’s crucial that you are as open as possible with your partners and friends. This is especially important for those of us who have BPD due to our emotion/thought dysregulation. The more we communicate, the more validated we will feel. We tend to keep our feelings and thoughts to ourselves because we fear we’re “overreacting” or “shouldn’t” be upset. In a healthy relationship, the other person really will listen to you and try to help despite those fears. Sometimes we need a little help to sort out the mumbo-jumbo in our brain.
- Support: It’s important to be with someone who will put effort into understanding BPD and what it means for you to have it. BPD is a huge part of our lives. Recovery is an on-going process and requires a lot of work and dedication. It can be quite hard if you’re not being offered the support you need by loved ones. Sometimes you may need a little extra help to keep yourself on the road to recovery. This is perfectly okay and encouraged. Having a strong support system can keep you feeling positive and appreciated, an important aspect of any recovery journey.
- Patience: Not only from your friends/family/significant other, but towards yourself. As you go through therapy (such as a DBT program) and learn new skills/ healthy ways to cope with stress, that patience will make a significant difference. The skills you learn will likely take a lot of time and energy from you. Be patientwith yourself. Your friends/family/etc. will need to understand this, too. They may not see progress for a while; change and growth take time. This doesn’t mean it’s not happening.
In conclusion: Although relationships can be difficult for us, they’re certainly possible. Our mental illness does not define our worth; BPD sufferers are very much worthy and capable of love.