Borderline Personality Disorder (BPD), what is it? Isn’t it similar to the Bipolar Disorder we’ve all heard about? NO! BPD is not another form of Bipolar. It is unlike all other forms of mental illness. It is the badass king of mental health disorders which is why I always state that anyone who battles this disorder also has to be a badass themselves to manage, survive and live with this disorder. This disorder is so bad that many doctors will not accept BPD patients. That alone should tell you something when the medical profession is unwilling and unable to handle a person with BPD. You cannot imagine what it is like to have a medical or mental health professional tell you they refuse to treat you because of your disorder as I have, so let’s venture down the rabbit hole and peer through the looking glass.
It appears that Borderline is caused by both genetic and environmental factors. For example if one parent has the disorder and passes it on to the child, by adding in poor parenting, specifically in a lack of nurturing which creates abandonment issues, the child is more inclined to exhibit BPD symptoms. BPD also stems from emotional and/or sexual abuse of the child, which occurs early on in the child’s life. BPD is most commonly diagnosed in women (about 75%) over men, contributing to the popular misconception that BPD is a “women’s” mental health disorder. This however is a myth as just as many men have this disorder as women do. Because men are more prone to show aggressive traits, it is easy to believe that the man is simply being physically and or emotionally abusive towards someone. The fact that men often fail to talk about their feelings makes it harder to diagnosis bad behavior from mental health issues. It takes a formal diagnosis and testing to be conclusive to determine whether a person has BPD.
The symptoms of BPD typically begin to appear in the pre-teen and teenage years, becoming more severe in the 20s and 30s. I started exhibiting symptoms as young as five years old. For many reasons, the thoughts are that it isn’t beneficial to diagnose very young people as the co-disorders of BPD often disguise and confuse the situation creating misdiagnoses. Also, as a person with BPD begins to age, the symptoms can lessen due to the maturing of the brain and improved treatment of the symptoms via therapy and psychiatric medications. Researchers also believe the brain is known to “burn out” the symptoms of BPD as the person ages. I can attest that I started to get much better in my 40s and 50s as the severity of my symptoms is concerned. I also spent much time throughout my adult life researching my symptoms and seeking treatment.
There are stages a Borderline goes through after receiving a diagnosis. Remember, I stated earlier that this is one of the worst of the mental health disorders. Therefore, it is reasonable for the stages to go as follows: confusion, resistance, anger, depression, acceptance and therapy. BPD is a diagnosis that carries a huge stigma label with it. Because of this reason, many with this disorder choose not to divulge that fact. It took me into my 50s to talk about it with people other than my family and very close friends.
Unfortunately, physical disorders like migraine headaches, fibromyalgia along with other co-occurring mental disorders like Depression, Panic Anxiety Disorder, PTSD, Obsessive Compulsive Disorder, ADHD, Bipolar 1 and Bipolar 2 and substance abuse disorders are found in people with BPD more so than in the general population. The emotional mood swings that accompany BPD can lead to self-harm behavior, such as cutting, as well as suicidal thoughts or actions.
All people experience a degree of emotional turmoil and instability from time to time. For the person with BPD, there is an ongoing pattern of instability. This interferes with their daily functioning and their ability to maintain relationships. Borderline isn’t as well-known as other major mental health conditions, such as depression, anxiety and schizophrenia. The word ‘Borderline’ in BPD can be very misleading. In the early days clinicians believed that BPD, was a “Borderline” state between neurosis and psychosis. While that is no longer the case, some people feel the word ‘Borderline’ is stigmatizing.
Although Borderline Personality Disorder can never be totally “healed”, the symptoms can be managed, and the person with BPD can learn to live a life that is fulfilling and gratifying. It is a long and tumultuous road, but once there, the change is beautifully dramatic.
There are nine specific symptoms for Borderline used as diagnostic criteria. In order to receive a Borderline diagnosis, a person must have at least five of the nine symptoms. Rather than looking at a single symptom, it is now common to list symptoms of the disorder into four groups or domains.
Domain A – Excessive, unstable and poorly regulated emotional responses. The most commonly affected emotions are anger, anxiety and depression.
- Affective (emotional) instability including intense, episodic emotional anguish, irritability, and anxiety/panic attacks.
- Anger that is inappropriate, intense and difficult to control
- Chronic feelings of emptiness.
In addition, the BPD may also experience over reactivity (emotional storms) and emotional responses that are occasionally under reactive or frequent episodes of loneliness and chronic boredom.
Domain B – Impulsive behaviors that are harmful to the BPD or others.
- Self-damaging acts such as excessive spending, unsafe and inappropriate sexual conduct, substance abuse, reckless driving or binge eating.
- Recurrent suicidal behavior, gestures, threats or self-injurious behavior such as cutting of hitting themselves. Engaging in other impulsive behaviors such as actions that are harmful and destructive to themselves, to others or to property.
Domain C – Inaccurate view of themselves and others with a high level of suspiciousness and other misperceptions with regard to other people.
- A markedly and persistently unstable self-image or sense of identity.
- Suspiciousness of others thoughts about them. Including paranoid ideation or severe dissociative episodes (transient and stress related) during which a person feels that they or their surroundings appear unreal. Other symptoms include having impaired social reasoning under stress along with impaired memory such as split or all or nothing thinking, difficulty pulling thoughts together so they make sense, and rational problem solving, especially in social conflicts.
Domain D – People with BPD experience tumultuous and very unstable relationships.
- Engaging in frantic efforts to avoid real or imagined abandonment.
- The Borderlines relationships may be very intense, unstable, and alternate between extremes of over idealizing and undervaluing people who are important to them. Recognition of overly dependent and clinging behavior in important relationships. They may also have an overly dependent and clinging behavior in important relationships.
The well-known author, survivor and clinician of Borderline Personality Disorder, Marsha Linehan, sums it up with her perfect quote: “People with BPD are like people with third degree burns over 90% of their bodies. Lacking emotional skin, they feel agony at the slightest touch or movement.”
Borderlines are known for their rapid mood swings and what is called cycling of their emotions. One minute they are down in the dumps depressed, the next they are just fine and happy and out the door. This causes a constant state of turmoil and upheaval in their personal lives and relationships with others. People with BPD live and die by their emotions. Lacking the ability to see the gray in a situation they live and fluctuate between black and white in their brains, seeing things as either all good or all bad. This is the most frustrating aspect of having this disorder. The flipping from black to white many times throughout the course of the day leaves a person with BPD exhausted and conflicted as to what reality truly is. One of my therapists said to me once that having Borderline affects the body physically. An example of this would be driving 90 miles an hour with the parking brake on.
We love you one minute and hate you the next, leaving the non-Borderline person in a state of never knowing where they stand in a relationship with someone with BPD. For this reason alone, having Borderline can mean walking a lonely road. Until a person with BPD is properly diagnosed, treated and medicated for this condition their life is one big upheaval.
Borderlines are very sensitive and intuitive to the moods of others. We can read people very well and usually know what you're feeling before you do! Asking a Borderline to think in a logical and analytical manner would be like asking Albert Einstein to play a love sonnet. It just does not come naturally to us. We always tend to put our emotional thoughts first which is what rules in our decision-making processes.
I remember when I was young and undiagnosed; I just naturally assumed that everyone else was like me. I could never understand why people constantly told me I made too much of an emotional production out of things and took things too personally. It is very confusing to someone with BPD considering the fact that we are missing the emotional regulation part of our brain.
An article on the National Institute of Mental Health (https://www.nimh.nih.gov/news/science-news/2008/emotion-regulating-circuit-weakened-in-borderline-personality-disorder.shtml), discusses the difference in the working brain tissue, called grey matter has been linked to impaired functioning of an emotional regulating circuit in patients with BPD. It further states how people with BPD have an excess of grey matter in the fear hub area deep in the brain which when over activated creates a deficit taking the brakes off a runaway fear response. The article covers much more, and I only mention it to include the scientific mumbo jumbo to prove the point that there is a true physiological impairment to the brain of a BPD and not some histrionic, made up condition that those of us with BPD live with and enjoy.
The fact of the matter is that the suicide rate for people with BPD is 50% higher than that of the general population. When you factor in the high state of emotional upheaval that someone with BPD lives with day after day, it is no wonder. Many of us also suffer from severe depressive episodes and panic attacks that are very debilitating and leave us incapacitated and in a state of just wanting to give up. Until we learn how to manage our emotions to the best of our ability, it is quite a hellish thing to live with.
I find that Borderlines spend much time in their lives trying to explain their thoughts, emotions and actions to others. I find that non-Borderlines spend much of their time trying to figure out and apply logic and analytical thought processes to the person that has BPD. I have a Blog on my website called Circular Conversations that explains this process (http://searchingforgrey.com/wp/2017/08/07/circular-conversations-with-a-bpd). It is exhausting for both parties and usually futile. As I get older, the less explaining I do and the more I just go with it, the better.
My very first therapist, the renowned Dr. Joyce Burland used to tell me that Borderline Personality Disorder was one of the most maligned mental illnesses and or diagnosis. I have found this to be true in living a life with it. In my personal experience, I have finally come to a point where total frustration and contempt for how misunderstood the disorder is, has led me to a place of devoting the rest of my life advocating for and educating people about BPD.
BPD is a difficult illness for everyone, but one that with education and training does not have to destroy lives. I am living proof of this. It hasn’t been easy, but I have been able to marry my husband of many years, raise a family, and hold a career. This is something rare but possible for people with BPD. I am not bragging, since most BPD’s commit suicide before age thirty, just surviving is an accomplishment.
It has also helped that I had a strong support system during my tumultuous years while undergoing treatment and learning how to manage my symptoms. There were many times early on, where I would go into episodic overload and lock myself in a dark closet. My struggles are real. The struggles of all BPD’s are real. We do need love, support and a good bit of understanding from those around us while we figure things out. Remember, our brains are wired differently so we can’t just pull ourselves together at times as people wish. Our lives are messy. In addition to a lot of therapy and other treatments such as CBT and DBT, we need medications to help control our symptoms, which in itself can be a whole other issue until the right medication and dosage is achieved.
It is due to my own survival, knowledge and understanding, which has fueled my desire to help others to have the knowledge and support that was lacking in my early days. Part of this mission is this blog, my upcoming book Searching for Grey, and my training and speaking with NAMI (National Alliance on Mental Health). My efforts to EMPATHIZE, EDUCATE, and ADVOCATE for those with BPD and mental health is my response to the uneducated population in regards to BPD. I write not only my own personal journey and experiences, but also that of tried and true conclusive statistics and evidence as to the symptoms we live with. It is my attempt to make sense of the senseless.
If you're on our website, then you've seen our slogan to Empathize, Educate, Advocate. As with any illness, be it physical or mental, it is imperative to understand what the person who lives with it is going through. To empathize and understand the condition puts others in a position of wanting to help make a difference in the life of that person and their suffering. This leads to a stance of wanting to educate others about the disease or disorder. Hopefully, it will eventually add an attitude of advocacy, and this is where the work is done. There is currently not much advocacy being done on behalf of those of us suffering with Borderline Personality Disorder. We have a bad rap as depicted in movies and books and I am here to lend a voice of hope and education with regard to BPD. I encourage you to join me, as there is much to do in this arena.
Hoping to have shed some light, Alice Pirola