The month of May is Borderline Personality Disorder Awareness Month. For the month of May, I decided to make a post every single day for BPD Awareness. Unfortunately, life things happened, which kept me from continuing the project, but it will be finished in time.
What is Borderline Personality Disorder? At first, it was believed to be on the borderline of psychosis and neurosis, hence the name, but that has since been disproven and is now believed to exist on its own spectrum. BPD 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.
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. 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.
Most people experience emotions on a scale of 3 to 7, only going outside of that frame in unique circumstances. Someone with BPD consistently experiences their emotions on a scale of 8 to 10. This can be incredibly exhausting! However, because of this, people with BPD tend to be incredibly passionate people. They experience things very intensely, which may make them overwhelming people at times, someone with BPD may be one of the most passionate people you know!
Despite struggling with self-identity, people with BPD are certainly one of a kind. They strongly cultivate their individualism and enjoy applying their abilities to new tasks. Once they find a niche, they are unstoppable.
People with BPD are incredibly spontaneous and prefer to live in the moment. They tend to be more free-spirited and can be refreshing to be around because they are usually willing to try new things and can be incredibly adventurous. They also tend to be incredibly curious and take great interest in the world around them and the people who inhabit it.
Contrary to popular belief, a common symptom of BPD is heightened empathy. People with BPD are very insightful and read people well. In fact, they tend to pay so much attention to other people, they have to be reminded to take care of themselves! High empathy in combination with the inability to feel anything less than an 8 on a scale of 1 to 10 can be incredibly distressing, and someone with BPD can be incredibly sensitive to things going on in a loved one’s life. In fact, it’s not unlikely you can be upset about something, and your borderline friend responds by being more upset than you are!
Many people with BPD are described by peers as bold people, able to speak their minds and often displaying lots of bravery. This is pretty common, with the combination of intense feelings, compassion and empathy for others, and spontaneity. Someone with BPD is very likely to leap to a friend’s defense quickly.
Despite mainly being diagnosed in adulthood, BPD can show signs in adolescence and even childhood. While many professionals tend to disregard the possibility of a diagnosis in minors, it’s actually even more important to address symptoms as soon as possible in hopes of preventing the symptoms from developing further and making life harder for the potential borderline patient.
Ultimately, BPD develops alongside the human personality, so professionals are hesitant to make the call until a person’s personality is fully developed, so between the ages of 18-21. (I disagree and think for personality it’s more 25-27, but I digress.) However, like personality traits, BPD traits can be present for the entirety of someone’s life. Many adults with BPD can recall having certain traits as early as five years old.
More or less, it’s not called a “personality disorder” because there’s something wrong with your personality, but because it develops alongside your personality. You always have a personality, but your personality doesn’t really “blossom” so to speak until early adulthood, which is when the diagnosis for a personality disorder is usually made. Personality disorders work the same way. They are almost always present, but they don’t normally make their presence known or even fully develop until early adulthood, although it varies depending on the individual.
However, one does not need a diagnosis in order to get treatment for symptoms. If you are a minor and suspect you have BPD or are displaying borderline symptoms, it’s important to seek treatment for those symptoms. You do not need a label to benefit from BPD treatment, such as DBT skills and other forms of therapy. The sooner you get treatment, the easier it will be once you hit adulthood, when BPD reaches it’s peak. (BPD Is suspected to be at its worst between the ages of 20 and 25, although it can vary depending on the individual.)
1) 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!
2) 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.”
3) 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.
4) 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?”
5) 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.
6) 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.
7) 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.”
Similar to bipolar’s hypomanic and manic episodes, people with BPD can also experience manic symptoms. (Note: the difference between mania and hypomania is that mania has that presence of psychosis.)
People with BPD often do experience elevated moods. They feel things incredibly intensely, whether it’s sadness or happiness or anger or anything else. Sometimes, this can trigger a state very similar to hypomania. An elevated mood can be so intense that it can boost one’s creativity and productivity. It’s really common, since BPD consists of extreme mood swings. Someone with BPD may also become more talkative, have an increase in their self-esteem, experience racing thoughts, become easily distracted, and these states can also trigger spontaneity in BPD. In some cases, these hypomanic symptoms can trigger some mild psychosis, mostly in the form of rapid and disorganized thinking and speech.
The difference is that manic and hypomanic episodes as they are seen in bipolar last days or weeks. With BPD, it can last a few minutes or a few hours. They are much shorter and probably don’t qualify as full “episodes.“ Of course, someone can have both bipolar and BPD and experience the flights of hypomania or mania as well as full-blown episodes.
If you have BPD, you may feel you are more emotionally sensitive than your peers. You may feel you are able to read people better. You may spot “red flags” in someone’s behavior much faster than your friends do. You may judge others quickly because you feel you are able to read them so well.
Well, guess what! There are studies to prove that people with BPD actually are more sensitive to the words, actions, body language, and tone of other people.
In one study, researchers took 20 individuals with BPD and 20 individuals without BPD and had the try to accurately define emotional expressions. The borderline patients consistently scored higher in recognizing the emotions in the faces they saw, and when the faces morphed and became a different emotion, the borderline participants were able to pinpoint the second emotion more quickly and more accurately than non-borderline participants. Because of this, it is believed emotional sensitivity is a core feature of BPD.
One emotion the borderline participants seemed to interpret inaccurately, however, was neutral or bored faces. Neutral expressed were often interpreted as a negative emotion, namely anger or fear. Even outside of studies, borderline individuals tend to read neutrality in their loved ones as anger. One conclusion drawn from these studies is that people with BPD tend to see other people as a threat, and they also see the world as dangerous.
People with BPD also tend to assume the anger (real or imagined) is directed at them rather than an anger or annoyance at something unrelated. For example, someone can be irritated with a work day, but someone with BPD may interpret that as anger which is directed at them and assume they have done something wrong, despite having nothing to do with what happened to irritate the other person.
May 7 - Borderline Misconceptions and the Truth About BPD
As many of you well know, people with BPD face an incredible amount of stigma in media, in society, and even amongst the field of psychiatry. Some mental health professionals believe people with BPD to be “problem patients” because of their intensity. Most people with BPD have at least one horror story to share about something said to them by a psychiatrist or other psych professional. (For example, I remember being told by a therapist after I was diagnosed in the hospital, “They told you that you have BPD? You’re too nice to have BPD. People with BPD are hateful, and you just seem like a nice girl.”)
So let’s get the facts straight and debunk some myths, shall we?
1) “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.
2) “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.
3) “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.
4) “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.
5) “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.
If you think you have BPD, and you’re planning on getting a professional diagnosis, there are a few things you can do. First of all, Finding the Right Therapist. You want to make sure you find someone who is willing to listen to your concerns and is respectful of your research. In many cases, therapists find it helpful when patients have done homework! The more you know, the quicker they can do their job and get your treatment ready. Recovery take team effort, and you and your therapist are partners on that team.
Something you may want to do is keep a mood diary for a week or two and keep track of your moods to show your therapist. This way they can know how rapid your moods are and the nature of them. Be sure to include what triggered your moods, if they were triggered (or mention “no trigger” if not). Include how you dealt with the mood.
For a lot of people, I also recommend filling out the BPD Checklist and rating each symptom listed on a scale of 1 - 5, 5 being the most severe. You can fill out the checklist and hand it to your therapist or other mental health professional to communicate your symptoms and the severity at which you experience them.
You can also have someone close to you fill out the checklist for you and see how it compares with yours. Sometimes, your loved ones will notice symptoms you don’t.
Also, keep in mind that even if you don’t get a diagnosis, you don’t need the label to get treatment for your symptoms. Anyone can benefit from therapy, and you don’t need to be “sick enough” to deserve help. Try not to be afraid of whether or not you get a diagnosis. You can still receive treatment for your symptoms, and if you have a good therapist, they will work with you to get a treatment which works best for you.
Depending on how long you’ve been in the BPD community, you may have heard the name Marsha Linehan come up a few times. Just who is she anyway?
Marsha Linehan is a psychologist and author, and she is also the creator of DBT (Dialectical Behavior Therapy), the main form of therapy used for borderline patients. While she created the therapy for BPD specifically, it has proved useful for various disorders and is used in many forms of treatment. She is also a psychology professor at the University of Washington.
Many psychologists celebrated DBT and her findings and agreed that DBT was one of the biggest breakthroughs of psych history. However, Linehan later revealed that she was diagnosed with BPD, and people immediately tried to discredit her research.
Despite this, DBT continues to be a common form of therapy for a variety of mental disorders, and Marsha continues to focus her research on BPD and its treatment, having BPD herself. Over the years, she’s earned several awards for her research and clinical work, including the Louis Israel Dublin award for Lifetime Achievement in the Field of Suicide in 1999, The Outstanding Educator Award for Mental Health Education from the New England Educational Institute in 2004, and Career Achievement Award from the American Psychological Association in 2005. She’s also published several books, such as Cognitive-Behavioral Treatment for Borderline Personality Disorder and Skills Training Manual for Treating Borderline Personality Disorder.
Dialectical Behavior Therapy (DBT) is a common form of therapy used on patients with borderline personality disorder. It is a cognitive-behavioral approach which emphasizes on the psychosocial aspects of treatment. The treatment works on symptoms which lead people to react in a more intense and out-of-the-ordinary manner toward certain emotional situations, especially those found in romantic, family and friend relationships. DBT theory suggests that some people’s emotional sensitivity in such situations can increase far more quickly than the average person’s, attain a higher level of emotional stimulation, and take a significant amount of time to return to a calmer state.
Characteristics of DBT
Support-oriented: It helps a person identify their strengths and builds on them so that the person can feel better about themselves and their life.
Cognitive-based: DBT helps identify thoughts, beliefs, and assumptions which make life harder: “I have to be perfect at everything.” “If I get angry, I’m a terrible person” & helps people to learn different ways of thinking which will make life more bearable: “I don’t need to be perfect at things for people to care about me”, “Everyone gets angry, it’s a normal emotion.
Collaborative: It requires constant attention to relationships between clients and staff. In DBT, people are encouraged to work out problems in their relationships with their therapist, and the therapists to do the same with them. DBT asks people to complete homework assignments, to role-play new ways of interacting with others, and to practice skills such as soothing yourself when upset. These skills, a crucial part of DBT, are taught in weekly lectures, reviewed in weekly homework groups, and referred to in nearly every group. The individual therapist helps the person to learn, apply, and master the DBT skills.
Generally, DBT works both in group sessions and one-on-one sessions with a therapist.
May 12 - Percentage of People with BPD and Co-Morbid Personality Disorders
If you have BPD, it is also likely you have more than just BPD. Not only are people with personality disorders more likely to develop Axis I disorders (mood disorders, anxiety disorders, etc.), but they are also more likely to meet the criteria for more than one personality disorder. If you know someone with a personality disorder, and they give you a list of other diagnoses along with it, that’s actually not uncommon at all! It’s actually better to think of PDs in the sense of, for example, you have a personality disorder with paranoid, schizoid, and avoidant traits.
Like a salad. Some people have onions and others have olives. Some people have both. It’s all still a salad. /end food metaphor
Here, I have compiled a list of the expected percentage of people with BPD with other personality disorders:
31% of people with BPD also have Paranoid Personality Disorder
6 % of people with BPD also have Schizoid Personality Disorder
16% of people with BPD also have Schizotypal Personality Disorder
23% of people with BPD also have Anti-Social Personality Disorder
30% of people with BPD also have Histrionic Personality Disorder
19% of people with BPD also have Narcissistic Personality Disorder
39% of people with BPD also have Avoidant Personality Disorder
36% of people with BPD also have Dependent Personality Disorder
12% of people with BPD also have Obsessive-Compulsive Personality Disorder
(Source: Taken from the third volume of Psychiatry by Allan Tasman, Jerald Kay, Jeffrey A. Lieberman, Michael B. First, and Mario Maj. Take statistics with a grain of salt, as I believe it is from the time of the DSM-III, so percentages are more likely “in the ballpark” rather than exact numbers.)
There are ten different kinds of personality disorders, and they are organized into three separate clusters, although they share similarities regardless.
Cluster A consists of the eccentric disorders, the personality disorders often associated with the schizophrenic spectrum. These include Paranoid Personality Disorder, Schizoid Personality Disorder, and Schizotypal Personal Disorder.
Paranoid Personality Disorder (PPD) is marked by a pattern of irrational suspicion and mistrust of others, interpreting motivations as malevolent.
Schizoid Personality Disorder (SZPD) is marked by a lack of interest and detachment from social relationships, apathy, and restricted emotional expression.
Schizotypal Personality Disorder (STPD) is marked by a pattern of extreme discomfort interacting socially, and distorted cognitions and perceptions.
Cluster B consists of the dramatic and emotional disorders. These include Anti-Social Personality Disorder, Borderline Personality Disorder, Histrionic Personality Disorder, and Narcissistic Personality Disorder.
Anti-Social Personality Disorder (ASPD) is marked by a pervasive pattern of disconnect from others, lack of empathy, difficulty maintaining themselves in social situations, and impulsivity.
Borderline Personality Disorder (BPD) is marked by a pattern of instability in relationships, self-image, identity, and moods.
Histrionic Personality Disorder (HPD) is marked by anxiety surrounding how they are treated and excessive emotions. They often need to place themselves at the center of attention.
Narcissistic Personality Disorder (NPD) is marked by a pattern of unstable self-image and fluctuating self-esteem combated with narcissistic behaviors, as they depend on the opinions of others in order to define themselves.
Cluster C consists of the anxious and fearful disorders. These include Avoidant Personality Disorder, Dependent Personality Disorder, and Obsessive-Compulsive Personality Disorders.
Avoidant Personality Disorder (AVPD) is marked by pervasive feelings of social inhibition and inadequacy, and extreme sensitivity to negative evaluation.
Dependent Personality Disorder (DPD) is marked by a pervasive psychological need to be cared for by other people and to seek their approval.
Obsessive-Compulsive Personality Disorder (OCPD) is marked by an intense perfectionism which applies to themselves and to others, and a conformity to rules.
Many people with BPD also experience brief episodes of psychosis, a symptom which is incredibly misunderstood by a great percentage of the population. Most people don’t seem to know what it actually means to be psychotic, partially due to false representation in the media.
There are many forms of psychosis, and one doesn’t have to be hallucinating or having delusions in order to be experiencing psychosis, although those are part of it too. One common form of psychosis is disorganized thoughts and speech. People experiencing psychosis may have changes in their thinking patterns. For example, they may have difficulty when they try to concentrate, follow a conversation or remember things. Thoughts may become jumbled, or they may not connect in a way that makes sense. Sentences may be unorganized, and they may have to repeat themselves or correct their sentences while speaking.
And as I mentioned, people experiencing a psychotic episode often develop false beliefs called delusions. A person may be truly convinced of a belief that is not shared by others, and even the most logical argument cannot change their mind. Examples of such beliefs include believing that one is being followed by others, or being monitored by cameras, or believing one’s thoughts are being controlled by an outside force. These delusions are often rooted in anxiety and results in the person with psychosis taking extra measures to protect themselves, NOT reacting violently towards others. They are actually more likely to hurt themselves than other people.
During psychosis, people may also hear, see, smell, taste or feel something that is not actually there. For example, they may hear voices or noises that no one else hears, see things that are not there, or experience unusual physical sensations. This is called hallucinating. It’s not always seeing things which aren’t there, but can apply to any of the five senses. Auditory hallucinations are actually the most common form of hallucination.
Psychosis can also cause incredibly intense mood swings. People experiencing a psychotic episode may behave differently from how they usually do. Often the changes in behavior are associated with the symptoms described above. People may laugh at inappropriate times or become upset for no apparent reason. They may spend more time alone or seem less interested in friends, school or work. The symptoms of the illness may also disrupt sleeping and eating patterns. Some people experiencing a psychotic episode may feel very depressed, and sometimes even suicidal.
Psychosis in BPD can consist of all of these things, and it can also make the other traditional symptoms of BPD a lot worse than they are normally.