Borderline Personality Disorder (BPD) is one of the most misunderstood personality disorders; probably in part due the non-descriptive name it’s been given. The term “Borderline” was first introduced in the United States in 1938. It was a term used by early psychiatrists to describe people who were thought to be on the “border” between psychosis and neurosis. At that time, people with neurosis were believed to be treatable, whereas people with psychoses were deemed untreatable. Since those days we have learned a lot more about BPD, but the old name still lives on.

So, what is BPD? Imagine having third degree burns covering the vast majority of your body. The pain you’d experience would likely feel unbearable. Every little movement or slight touch would be agonizingly felt.

Much like the burn victim’s pain, the BPD sufferer has extremely thin emotional skin – leaving them to struggle with regulating their emotions, behaviors, and thoughts while at the same time searching for some way to reduce or displace the discomfort.

While only about 1.6 percent of the population is diagnosed with Borderline Personality Disorder, psychologists believe that many BPD sufferers are often misdiagnosed and under-diagnosed. This may be related to its high comorbidity rate with (meaning it’s often paired with) other mental health conditions like anxiety, depression, eating disorders, PTSD, substance abuse and bipolarism. The disorder affects three times as many women as men – making it more a women’s issue than men’s. People with BPD can often spend years in therapy as they learn to tolerate their emotional discomfort and manage their lives.

Understanding Borderline Personality Disorder

Classified as a personality disorder, BPD is a long-term pattern of behavior characterized by unstable moods, emotions, relationships, and behavior. BPD differs from other personality disorders in that relationships deeply affect a person with BPD. The fear of facing separation or rejection can lead to self-destructive or self-harming behaviors – even suicide (an estimated 10% of BPD sufferers commit suicide).  BPD often prohibits your ability to find fulfillment in life, relationships, and work.

To be diagnosed with Borderline Personality Disorder, an individual must exhibit five of the following nine criteria:

• Desperate efforts to avoid real or imagined abandonment. This includes difficulty trusting anyone and significant strain on interpersonal relationships.
• A pattern of unstable relationships seesawing between extremes of both deep admiration and hatred. Relationships often are characterized by a lot of conflicts, arguments, and break-ups.
• An unhealthy and unstable self-image with many ups and downs in how they feel about themselves. One day you may feel good about yourself, but then the next feel bad or evil.
• Impulsive and self-damaging behavior such as overspending, sexual promiscuity, substance abuse, or binge eating.
• Suicidal tendencies and/or self-harm such as cutting or burning.
• Irrational and erratic mood swings which may feel like an emotional roller coaster ride (for example, going from feeling okay to feeling extremely down within minutes).
• Persistent and overwhelming feelings of emptiness.
• Anger and difficulty controlling that anger.
• Temporary (and often stress-related) paranoia and dissociative symptoms like thoughts that others may be trying to cause you harm or feeling numb – as if you’re not really in your own body.

Like many psychological disorders, the root cause of BPD is unknown. However, there seems to be some amount of both biological and environmental factors (nature vs nurture). Research suggests that many BPD sufferers often have experienced some sort of childhood trauma or neglect. There also appears to be some biological evidence in parts of the brain that impact impulse control and regulation of emotions – though it’s unsure if this is the cause or an effect of BPD. Furthermore, research supports a genetic link in having BPD and having a parent or sibling with BPD also.

What Types of Help are Available for BPD?

If you or someone you love was recently diagnosed with BPD, there are a few things you can do to work toward healing.

Seek Help. There are a few treatment options available. Psychotherapy is the standard treatment for BPD. There is also professional counseling for family and loved ones of BPD sufferers. Your mental health professional may also recommend medicinal help to treat some of the symptoms associated with BPD such as depression or mood swings.

Interestingly, BPD is really a personality trait and as such, it’s really not something that one can change or stop. However, through counseling, you can learn to manage it. Likewise, family members can better understand the interworking of it and what they can do to help, rather than harm, them. Often getting family on the same page can be one of the best treatment options for the BPD

If you or a loved one is having suicidal thoughts, call the National Suicide Prevention Lifeline at 1-800-273-TALK (8255). Someone is available 24 hours a day, 7 days a week. Calls are free and confidential.

Connect with a Support System.You are not alone and you do not have to suffer alone. It can be helpful in your recovery to have both an emotional support system and peer-support groups. Search online for support groups in your area or ask me to recommend one to you.

Avoid Triggers. Part of healing is making lifestyle changes to avoid triggers, which worsen your symptoms or prevent your recovery. Exercising, eating right and finding healthy ways to process stress are all part of your recovery. Avoid substances like drugs and alcohol, which can worsen your symptoms and impact your emotional stability.

While the life of an individual with BPD can feel confusing and it’s important to remember that their behavior is the result of a mental health condition and the symptoms are not their fault. They did not choose the condition, BUT they can choose (and you can choose) to seek help and healing. I work with Borderline Personality Disorder clients and their loved ones. We can journey through this together. It won’t be quick or easy, but it will be worth it. Let’s get started.

-Joel D. Walton

Here’s a great video on the difference between BPD and NPD.