Borderline personality disorder (BPD) is a psychiatric illness that affects how an individual interacts with other people.
It’s also surrounded in myths.
Here’s what it’s like to be in a relationship with someone with Borderline Personality Disorder
‘A person with BPD is needy and attention seeking’; ‘A person with BPD will only ever love themselves’; ‘They straddle the line between psychotic and neurotic’.
All of these are complete tosh.
If you’d like to understand more about what having BPD really means then read on.
What is borderline personality disorder?
BPD is one of the personality disorders currently listed in the DSM-IV.
Do not let the name fool you; I’ve found many people will be quick to say a person with BPD’s cannot change their behaviour because ‘it’s part of their personality’.
This is not the case, and some of us with it find that name more problematic than helpful because of those assumptions.
BPD can be characterised by a few key criteria.
Emotional instability: people with BPD feel emotions much more strongly than those without. Instead of feeling sadness we feel intense grief, shame and humiliation instead of embarrassment, and rage instead of annoyance.
Impulsivity: people will often engage in risky behaviour such as substance abuse, unprotected sex, binge eating or reckless driving. This behaviour is usually to find a ‘release’ from the pain of the aforementioned intense emotions.
Unstable personal relationships: along with that whirlwind of emotions, add a side order of paranoia and fear of abandonment, possibly but not always caused by childhood trauma, and you’ve got the recipe for some pretty rocky relationships.
Self-damaging behaviour: about 50%-80% of people with BPD engage in some kind of self-harm, with a range of methods and reasons for doing so. The reasons can be an expression of anger, self-punishment or trying to ‘ground’ yourself during a period of dissociation.
An unstable sense of self: people may not really feel they ‘know who they are’, leading to shifts in views, morals and tastes but nearly always leading to a feeling of ‘chronic emptiness’. In severe cases people can experience dissociation and psychosis similar to schizophrenia.
The chaos going on in our minds on a daily basis more often than not causes depression and anxiety – two key markers of BPD.
This list of symptoms can sometimes be hard to understand without applying it to a real-life person.
I’ll give myself as an example: If I were to describe myself kindly I’d say I was fair, empathetic and loving to a fault.
If I were to describe myself in a less kind way I’d say I was unpredictable, pessimistic, with a tendency to be clingy or aloof.
I find relationships difficult because I usually love people more than they love me, but spending prolonged periods of time with them causes physical panic attacks as the intensity of the emotions are physically overwhelming.
Feeling so strongly about everything leads to episodes of anger and intense stress, which can be difficult for people to be around at times.
I also get very low; a particular pain for myself and many people with BPD is that we love other people more than anything but our illness can sometimes prevent us from having the relationships we want.
This is a description of myself and does not speak for all sufferers; as with all mental health issues, symptoms vary between people.
What Causes BPD?
The jury is still out on this.
Earlier research correlated childhood trauma to development of BPD, but more recent research has shown there are much more complex factors.
Along with genetic, societal and developmental causes, studies have shown that the brains of people with BPD are physically different.
Your amygdala are the two parts of your brain that give you your emotions – all feelings are created here.
People with BPD have smaller but much more active amygdala (which helps regulate emotions) markedly so than people without, which may explain why we experience such intense feelings.
Coupled with your trigger-happy amygdala you have a lazy prefrontal cortex.
This part of your brain, among many things, is responsible for emotional regulation.
As an example, when it functions normally, the prefrontal cortex helps you calm down in ten minutes after a fight, rather than four hours after.
In people with BPD, however, it is underactive, which partially explains why we find it difficult to stem the flow once the emotional flood barrier is opened.
Finally, the hypothalamic-pituitary-adrenal axis (HPA axis) is an area of the brain responsible for producing cortisol, the stress hormone.
Studies have shown that People with BPD have an overactive HPA axis, which is a good start on explaining why we are so sensitive to stress and may develop anxiety disorders.
So, not to give room for the unhelpful phrase, ‘it’s all in your head’, but it is, only physically rather than just psychologically.
How is BPD treated?
Despite the popular misconception, BPD is not ‘treatment resistent’.
In fact quite the opposite: 68.6% of people who receive treatment for the disorder experienced remission over a six-year period.
Though there are no medications specifically approved for the treatment of BPD many people find the following helpful: antipsychotics can help reduce anger and suicidal behaviour, mood stabilisers can help with emotional regulation and certain antidepressants can help with depression.
More than likely along with these, though, you will be prescribed some kind of psychological ‘talking’ therapy.
The current approved set includes mentalisation-based therapy (MBT) and Dialectical Behavioural Therapy (DBT).
These help you plumb deeper into your emotional behaviours and ways of thinking to help you ‘self regulate’ when you start to feel unstable.
Does a BPD diagnosis mean my life is over?
No. However, about 10% of people diagnosed with BPD die from completing suicide each year.
It is a serious illness if left untreated, so if you feel you may be affected you must contact a health professional as soon as you feel able to and be given a formal diagnosis and treatment plan.
If you’ve just been diagnosed look here to see what you might expect after your diagnosis.
On a brighter note, a lot of people with BPD lead fulfilling happy lives, and yes also have normal healthy relationships.
Like any mental health issue the aim is not ‘recovery’, it’s maintenance, be it with medication, therapy, self-care or all of the above.
People that don’t have BPD also play an important role in people with BPD’s lives; learning about the illness can help your friend, partner, or co-worker with BPD feel more supported and more secure.
There are so many damaging stereotypes of this illness that have very little grounding in fact and a lot in the emotional experiences of others who meet people with BPD and these stereotypes are damaging for both parties.
I urge everyone to understand this illness, in the same way people have begun to understand anxiety and depression.
In doing so, hopefully, in the next 10 years the number of people struggling severely with this illness may start to decline.