Borderline personality disorder (BPD) is difficult to define in one sentence.
Because of the stigma and lack of clarity surrounding the condition, this article will aim to explain what BPD is, how it develops, and how it can be treated.
It may give you insight as to whether you or a loved one suffers from BPD, and what you can do about it.
Remember that just because BPD is a complex condition, it doesn’t mean that help is not available, or that BPD individuals cannot recover.
A Broad Overview of BPD
If BPD has a defining quality, it’s an impaired ability to regulate one’s emotions effectively.
This emotional volatility is said to be on the “borderline” between psychosis — losing touch with reality, and neurosis — intense negative emotion.
According to Psychology Today:
“People with BPD exhibit high rates of self-injurious behavior, such as cutting and elevated rates of attempted and completed suicide.”
The biosocial theory of BPD posits that chronically invalidating environments and one’s own biological sensitivity results in emotional dysregulation.
They often experience negative self-perception, relationship troubles, and impaired impulse control.
Borderline Personality Disorder — A Deep Dive
To gain a deeper understanding of the condition, we need to understand its core elements.
There are nine traits of the DSM-5 Borderline Personality Disorder criteria, only five of which are needed for a diagnosis.
1. INTENSE FEAR OF ABANDONMENT
BPD individuals attempt to avoid real or perceived abandonment.
The threat of abandonment can lead those with BPD to experience intense emotions, exhibit difficulty regulating their emotions, and ineffectively resolve interpersonal conflicts.
2. UNSTABLE RELATIONSHIPS
BPD individuals have a history of volatile or unstable relationships.
In relationships, someone may rapidly switch between idealizing a friend or romantic partner and devaluing them.
The idealization usually occurs early on in a relationship, with BPD individuals sharing intimate details of their lives and opening up quickly.
However, when this intimacy is not shared reciprocally, the person with BPD may feel unimportant and not valued. These feelings of loneliness may cause the person with BPD to devalue this person and friendship.
3. UNSTABLE SELF IMAGE
BPD individuals exhibit rapid changes in their identity.
This can come in several forms, including:
- Changing future goals and plans.
- Sexual orientation.
- Personal values.
- Views on friends or loved ones.
- Political affiliations.
- Career Choices.
These shifts in self-image may be more pronounced when the person feels unstable in their personal relationships or in situations where they are not supported.
BPD individuals often have a history of impulsive, self-destructive behavior.
Many individuals with BPD engage in impulsive behavior which is typically prompted by threats of rejection, invalidation, or an increased in presumed responsibility. Some examples of impulsivity include:
- Extreme Spending.
- Unsafe Sex.
- Substance Abuse.
- Reckless Driving.
- Binge Eating.
5. SUICIDAL BEHAVIOR AND SELF HARM
BPD individuals often engage in self-harm and suicidal behaviors.
Many individuals with BPD seek treatment due to self-harming and suicidal episodes.
Self-harm in BPD can result from disassociative experiences, serve as a source of relief from intense emotional turmoil, or act as a way of self-punishment. These self-harm and suicidal attempts are typically a result of experiencing emotional dysregulation, prompted by a specific event (i.e., perceived abandonment or rejection).
6. AFFECTIVE INSTABILITY
BPD individuals are subject to changes in mood and emotional reactions.
Heightened emotional sensitivity (although not harmful on its own) often results in BPD individuals experiencing emotional roller coasters.
This can come in the form of intense sadness, anxiety, or irritability. It can be difficult for a BPD individual to not get swept up by their passionate feelings.
7. CHRONIC EMPTINESS
BPD individuals report feeling “empty.”
In between moments of strong emotional expression, a BPD individual might appear sad or despondent. They often describe their baseline emotion as feeling “empty.”
When considering the origins of the condition, it makes perfect sense that a chronically invalidated human being with an unstable sense of identity might describe themselves as feeling empty.
8. FREQUENT INAPPROPRIATE ANGER
BPD individuals often have strong outbursts of anger.
Anger is an especially difficult emotion for a BPD individual to control. This anger, as with other emotional reactions, comes about from the threat of perceived rejection or disrespect from another person.
Angry outbursts can be followed by feelings of shame and guilt, which may further reinforce a negative self-image.
9. PARANOID IDEATION AND DISASSOCIATION
BPD individuals can occasionally disassociate.
During periods of extreme stress, paranoid thinking or dissociative symptoms (like de-realization or breaking off from reality) can occur.
These aren’t permanent states for BPD individuals (only lasting minutes to hours), but they are often another response to perceived rejection or relationship conflict.
How to Treat Borderline Personality Disorder
For a long time, BPD was notorious for being difficult to treat. However, with researchers gaining a deeper understanding of the condition in recent years and the development of new therapies, that sentiment has changed.
According to the NIH:
“…with newer, evidence-based treatment, many people with this disorder experience fewer and less severe symptoms, improved functioning, and better quality of life.”
DBT was specifically designed to treat BPD. It involves learning techniques for increasing self-awareness, managing emotions, and treating yourself in a kinder, more compassionate way while making the changes to live a more fulfilling and meaningful life.
The Four Modes of DBT
- Individual Therapy
One-on-one sessions with BPD patients are used to help enhance their motivation and apply newly learned skills. The goal is to get the patient to become independent in managing their emotions, relationships, and lives.
- Skills Training (Group or Individual)
DBT skills training is for giving BPD patients new ways to enhance their problem-solving and emotional regulation abilities.
The four skills: mindfulness, distress tolerance, emotion regulation, and interpersonal effectiveness, are taught with the assumption that the BPD patient is already doing the best they can. They only need to change their coping strategies.
- Phone Coaching
When a patient needs help in between sessions, they can call their therapist for in-the-moment phone coaching. The long-term goal is to teach the patient to manage difficult situations on their own.
- DBT Consultation Team
A therapist may consult and work with other therapists when taking a patient through DBT training. This is so the primary therapist can get external feedback and provide extra support to the patient.
A major principle of DBT is that negative emotions exist for valid reasons. Fighting against negative feelings is what makes them stick around and become overwhelming.
Mindfulness is the practice of becoming aware of one’s emotions and observing them as they are. DBT patients learn to recognize, describe, and name their feelings so that they can work to accept them.
Mindfully accepting one’s emotional state is what gives BPD patients the ability to use effective coping strategies in difficult moments. Mindfulness also serves as a form of exposure therapy for negative emotions, teaching BPD patients that their feelings are not something to be feared or rejected.
Through an artful combination of being aware of and connected to one’s feelings, BPD patients can manage their emotional dynamics in a significant way.
Committed, continued treatment works for most people diagnosed with BPD. And as far as treatments go, DBT leads the way.
According to the Berlin Borderline Study on long-term DBT effectiveness for BPD patients:
“At the end of the first treatment year, 77% of the patients no longer met criteria for BPD diagnosis.”
With the correct tools, skills, and understanding, BPD individuals can live more peaceful, fulfilling lives.