Borderline personality disorder is often misunderstood and may be challenging to accept for the person living with it and their family/friends. According to the DSM-V (Diagnostic and Statistical Manual of Mental Disorders), Borderline Personality Disorder (BPD) is a pattern of instability within interpersonal relationships, self-image, emotional dysregulation, and impulsivity which typically begins by early adulthood indicative by five (or more) of the following symptoms:
1. Frantic efforts to avoid real or imagined abandonment.
2. A pattern of unstable and intense interpersonal relationships by alternating between extremes of idealization and devaluation.
3. Identity disturbance: persistently unstable self-image or sense of self
4. Impulsivity in at least two areas that are potentially self-damaging
(spending, sex, substance abuse, reckless driving, binge eating).
5. Recurrent suicidal behavior, gestures, or threats, or self-mutilating behavior
6. Affective instability due to a marked reactivity of mood
(dysphoria, irritability, or anxiety usually lasting a few hours and rarely more than a few days).
7. Chronic feelings of emptiness
8. Inappropriate, intense anger or difficulty controlling anger
(frequent displays of temper, constant anger, recurrent physical fights).
9. Stress-related paranoid ideation or severe dissociative symptoms.
Experiencing few, some, or most of the symptoms above can make everyday living strenuous and overwhelming. The fear of abandonment may be rooted in childhood trauma or attachment styles, significantly influencing interpersonal relationships. Idealizing others or the extreme opposite and devaluing people may lead to a lack of appropriate social skills, unhealthy relationships, and potentially harmful behaviors. One may feel a lack of security in their decision-making process, low self-esteem, mistrust within themself, or a decreased confidence. In addition to a low or unstable self-image, one may engage in risky behaviors which can be dangerous to their mental health and physical health while impacting areas of life in terms of financial stability, career direction, personal development, etc.
One of the biggest concerns is evidence of self-harm via self-mutilation and suicidal ideations. Borderline Personality Disorder (BPD) is associated with higher rates of self-harming behavior and suicide, leading to necessary safety plans and intervention when experiencing recurrent high-risk factors. Intense mood change, irritability, and overall instability are common symptoms that may be present with feelings of emptiness. Inappropriate or heightened feelings of anger may also be involved making one’s effect feel in turmoil. Stress-induced paranoia is concerning when symptoms of mistrust or delusions negatively impact one’s well-being.
Where does it come from:
Borderline Personality Disorder (BPD) stems from a combination of genetic and environmental factors. There are specific biological predispositions along with the presence of childhood trauma, which may result in BPD. Genetic or biological predispositions may include a history of mental health in one’s family, infections as an infant, prenatal injuries, brain damage, exposure to toxins, etc. Environmental factors may include trauma during childhood, neglect, emotional, sexual, physical abuse, PTSD, substance use, natural disasters, unresolved grief, etc. The presence of both a biological disposition and one or more environmental factors may influence mental health leading to BPD. Childhood trauma serves as a threat to a child’s well-being, resulting in extreme distress and an affected physical/ mental state well through adulthood. Childhood trauma comes in many forms and may be suppressed, meaning it is unresolved.
Who does it affect?
Borderline Personality Disorder (BPD) is known to impact females more often than males, possibly due to stigma, underdiagnoses, or misdiagnosis. BPD is also commonly misdiagnosed as Bipolar Disorder, defined as a mood disorder with two extremities, including depressive episodes and manic episodes. This disorder is mainly associated with White females, although there are limited studies on race as a factor in BPD.
What types of treatment work best?
Treatment may be difficult for providers and those experiencing symptoms and diagnosed with Borderline Personality Disorder (BPD). Known methods of successful treatment include Cognitive Behavioral Therapy (CBT) and Dialectical Behavioral Therapy (DBT). CBT focuses on challenging harmful thought patterns/behaviors and replacing core beliefs to reflect less destructive behaviors, a reduction in self-harm, and an improved state of mind. DBT focuses on mindfulness and acceptance as the primary approach in being aware of maladaptive behavior and thoughts. This approach focuses on skill-building to improve interpersonal relationships, regulate emotions, and create healthier coping strategies.
Medication is also used in conjunction with psychotherapy to help treat the symptoms associated with Borderline Personality Disorder (BPD). Medications such as a mood stabilizer, antipsychotic, antidepressant, etc., may help stabilize one’s mood, improve feelings of depression/anxiety, and decrease suicidal ideations. Medication paired with psychotherapy helps increase one’s ability to function in day-to-day life.
The level of treatment is essential to consider, especially as the same treatment does not work for everyone living with Borderline Personality Disorder (BPD). Some people need in-patient hospitalization care to ensure they are monitored by medical staff 24/7 and have access to a team of professionals at any time. Others may seek extended treatment in an outpatient setting, including but not limited to Partial Hospitalization Programs, Intensive Outpatients, etc. These levels of care will ensure one has the appropriate medical care, skills, group therapy, access to psychiatrists/ therapists to navigate their lives once they complete their program and strive for a more independent lifestyle. Find more information about the most appropriate level of care here:
How to help people living with BPD?
You can help someone living with Borderline Personality Disorder by being involved and understanding while implementing the suggestions below:
1. Be patient, kind, and empathetic
Here is a friendly reminder to be patient with others. It’s easy to react quickly and with heightened emotion in the heat of the moment, especially when provoked. Take a moment, a breath, and reflect. Be empathetic towards those with BDP and understand what they may be going through and how they feel. Show kindness at this moment the best way you can.
2. Educate yourself
Through this blog, you have already started the process of education! Continue to read articles, watch videos, understand research, learn from their life experiences. Educating yourself is one of the most remarkable ways to invest in fully understanding and respecting this disorder. With time, you can be more empathetic and understand the symptoms and warning signs associated with BPD.
3. Communicate efficiently
One of the first steps of communicating well is being an active listener. Listen to understand, to be engaged, not necessarily to respond. Verbal and non-verbal cues are a large part of understanding how someone else may be feeling. Be aware of your tone and use words that describe the emotions you’re feeling to express yourself appropriately. Communicating will significantly benefit your relationship with someone living with BPD.
4. Create healthy boundaries
Know your limits and express them respectfully. Communicate your boundaries firmly and clearly. Boundaries will aid accountability by requesting a behavioral change. Boundary setting and upkeep will help facilitate a healthy and successful relationship. Boundaries are necessary for encouraging those with BPD to respect their interpersonal relationships.
5. Offer resources
Be an active participant in offering help to someone with BPD. Resources may include a referral to a great therapist, finding a helpful support group, or suggesting an insightful podcast for them. There are endless possibilities that come to play an active role in the life of someone living with BPD.
6. Stress management and self-care
Interpersonal relationships are tough to maintain, even without typical life stressors factored in. To fill the cup of others, you must first fill your own. Practice self-care and helpful stress management, such as aromatherapy, going for regular walks, listening to peaceful music, meditation, journaling, eating a healthy and delicious meal, using a stress ball, etc.
7. Be supportive
Be open to different perspectives, listen intently, and show your active support using words of affirmation. Help your friend or loved one with BPD during challenging times and know when to seek external help. Signs of instability, suicidality, self-harm, or extreme symptoms of depression/ mood swings may be a sign to seek external support. Speak to a medical professional, reach out to a support line, get another opinion if you feel your loved one with BPD needs additional help.
Following these steps will create a safe space to develop a stronger relationship and motivate your loved one to practice healthy skills to maintain the relationship and become the best version of themself. During this process, you may experience setbacks, hardships, and even conflict. Be realistic with setting different expectations with attainable goals for the friendship. These tips will ensure both you and your loved one living with Borderline Personality Disorder feel encouraged through this journey of life.