Borderline Personality Disorder, One of the Most Misunderstood Illnesses

Self-mutilation, rocky relationships, intense dysphoria and rapid shifts in mood.  These are just a few of the tough issues that plague individuals suffering from borderline personality disorder (BPD).

BPD is one of the most challenging disorders for both mental health and medical professionals.  This is largely because individuals with BPD are notorious for being “frequent flyers” – regular visitors to hospital ERs, doctor’s offices and mental health clinics.  They often push treatment providers and their staff to their limits while failing to make much, if any, progress, even despite years of treatment.

Christi’s story is just one example…


Christi is a 26-year-old white female who had been in and out of therapy since the age of 17.  Her parents first brought her in for treatment when they noticed multiple deep scratches and small cuts on her arms, which she admitted to doing to herself whenever she felt “bad.”  Christi had also been acting out in school, which seemed to be triggered by a dramatic breakup with her first serious boyfriend.  Her parents had also noticed increasingly severe and rapid mood swings – which seemed too extreme to chalk up to adolescent angst. Christi would be happy and calm one minute, and inconsolable, raging, or threatening suicide the next.  Day after day, this quickly became exhausting.


Christi’s first therapist correctly diagnosed her with BPD, and worked with her off and on for two years before finally referring Christi to a therapist who specialized in treating personality disorders. Christi had always been sporadic with treatment, but quick to demand a same day appointment whenever she had a crisis – which was often. 


At 19, Christi made her first suicide attempt, overdosing on a handful of her mother’s Paxil. She was hospitalized briefly in order to ensure her safety, and then released back into her therapist’s care.  It wasn’t long before Christi dismissed her current therapist, flying into a rage every time he refused to cater to her demands. 


Over the next few years, Christi’s self-mutilation and mood swings got worse, and her suicide threats and attempts became more frequent – even though none were truly life-threatening.  Her parents were exhausted from the frequent late night phone calls – if not from Christi, from the police or someone at the local hospital ER.  It didn’t help matters that she had also started drinking regularly, which made her low moods even lower, and her acting out behavior more intense. 


Christi finally enrolled in a dialectical behavior therapy program, a therapy originally developed specifically to treat BPD.  It was there that she began to make noticeable progress.  Although she had a rocky start, she gradually began to respond to the staff’s strict boundaries and well-structured treatment approach.  Her suicide threats and behavior had stopped and the cutting was now a very rare event.  DBT helped her learn how to manage her emotions well enough to enable her to maintain a steady job. 

It’s a rare therapist who doesn’t have at least one – if not a few – clients like Christi.  Her story is anything but unfamiliar.

Poor Coping Skills and Deeply Ingrained Traits

BPD is one of 10 personality disorders listed in the DSM, the diagnostic manual used by mental health professionals. Personality disorders, by their very nature, are deeply ingrained. The symptoms begin to develop early on and become fully fledged by late teens to early adulthood.  While symptoms may mellow somewhat in later life, a personality disorder is considered a lifelong condition.  Those who suffer from them have a distorted view of the world and of themselves, and they’re relationships with others are troubled and unhealthy.

While a borderline’s behavior may seem highly manipulative and really irritating, it actually stems from their failure to learn healthy coping skills as they were growing. They do what they do – frustrating as it may be to everyone else – in order to get their needs met.  It can be maddening to others who don’t understand what their tumultuous internal world is like.  But for those with BPD, they’re generally doing the best they can because they simply don’t know anything else.

Without appropriate treatment, individuals with BPD rarely change in any significant way.  Although some clinicians believe that treating any personality disorder is generally a futile attempt – because of their inflexible and deeply ingrained nature – BPD is actually the one personality disorder covered by some health care plans.  One of the reasons for this is because some individuals with BPD do respond fairly well to appropriate treatment, particularly DBT and similar types of therapy.

Unfortunately, due to the often extreme behavior and intense emotional displays, a diagnosis of “borderline personality” carries a significant amount of stigma.  While life can be very painful and difficult for those who suffer from BPD, their impact on those around them is also often very negative.  This makes it difficult for some to feel compassion for those who suffer with this particular psychiatric disorder.

On the ‘Border’

While the names of some personality disorders make somewhat obvious sense, such as “narcissistic” or “antisocial” personality, the term “borderline” is confusing – especially if you don’t know the history behind it.  The term originated in the 1930s based on the observation that certain patients had symptoms that suggested they were on the “border” of psychosis and neurosis but didn’t clearly fit into either diagnostic category.  The name has stuck, despite many efforts over the years to change it to something more clinically appropriate.

Despite the early origin of the name, it should be noted that BPD is not considered a psychotic disorder, like schizophrenia or delusional disorder.

The Clinical Picture

Entire books have been written about BPD, with lengthy chapters discussing the various complex symptoms and underlying issues.  Following is a brief overview of the symptoms associated with a diagnosis of borderline personality disorder:

Rapid, unpredictable and frequent changes in mood. Unlike individuals with bipolar disorder, whose manic or depressive episodes typically last for several days or even weeks, individuals with BPD can have multiple mood changes within a given day – or even in just a couple of hours.  They tend to have very low lows, known as “dysphoria,” and sudden “highs.”  Their negative moods (and rage) are often influenced by a profound sense of abandonment.

Profound fear of abandonment. Abandonment issues are one of the hallmark features of individuals with BPD. It’s not uncommon for them to have a history of childhood abuse or neglect. It is especially hard for most individuals with BPD to handle being alone or feeling rejected. The abandonment may be imagined or real, and often elicits frantic efforts to avoid it on the part of the borderline individual.

Self-mutilation, and/or frequent suicidal threats and behaviors. Individuals with BPD experience intense negative emotions. They also tend to perceive themselves as inherently bad. As a result, they often engage in self-mutilation (e.g. cutting or burning) to cope with their painful emotions or punish themselves. Suicidal behavior is often manipulative in nature, but can also stem from a desire to escape the chronic and intense emotional suffering.  Approximately 10% of individuals diagnosed with BPD die via suicide.

Poor emotional regulation. Most people learn to manage – at least to a reasonable degree, most of the time – intense negative emotions. Individuals with BPD lack this ability, and find it extremely difficult to self-soothe. Instead, they’re more inclined to act out as a result.

Inappropriate anger or rage. Many individuals with BPD not only feel anger at a deeply intense level, they have a very difficult time controlling angry feelings. The rage of a borderline can be extremely intense and deeply hurtful.  It may even lead to physical fights and other types of violent behavior (e.g. slashing the tires of an ex-lover).

A history of rocky and short-lived relationships. Their fear of abandonment, mood swings, anger outbursts and intense emotions make it especially difficult for individuals with BPD to have stable, lasting relationships. Additionally, they also tend to go back and forth between devaluing and idolizing those close to them. One minute they’re head over heels in love with their significant other or think their therapist is a saint, and the next they’re disgusted and angry, refusing to talk or treating the other person horribly.  Needless to say, this behavior makes for a long history of damaged and often volatile relationships.

Unstable, fragile sense of self. As mentioned above, individuals with BPD often believe they are somehow inherently evil or bad. Their self-perception can shift often, leading to frequent changes in future plans or goals, personal opinions or values and even how they identify themselves sexually.

Impulsivity. When you combine impulsive tendencies with someone who experiences intense emotions, mood swings and frequent changes in self-image, you have a recipe for disaster. Individuals with BPD often engage in high-risk behavior that tends to be self-destructive in nature, such as drug abuse or promiscuity.

Chronic feelings of emptiness. Since individuals with BPD tend to get bored very quickly, they are always looking for ways to fill the emptiness and escape the boredom. Unfortunately, the choices they make are often not in their best interest.

Brief episodes of paranoia or dissociation. Individuals with BPD can lose touch with reality for brief moments. This usually occurs in response to extreme stress or when they fear they have been abandoned.


Despite the chronic and typically inflexible nature of personality disorders, treatment can be effective for some individuals with BPD. While psychotherapy is the preferred and most effective form of treatment, there may be times when brief hospitalization is indicated. Medication may also be beneficial, usually to treat co-occurring symptoms such as depression or anxiety as opposed to the personality disorder itself.

Dialectical behavior therapy is generally regarded as one of the most effective types of psychotherapy for individuals with BPD. Developed by Dr. Marcia Linehan, DBT addresses the three primary areas of struggle for borderlines:  regulating emotions, managing stress and developing healthy, stable relationships. DBT programs are highly structured and ideally utilize a team of clinicians.

Psychiatric hospitalization is often discouraged in the treatment of BPD due to the nature of the disorder. However, it is sometimes necessary for those who are mutilating themselves to a dangerous degree (e.g. deep cutting that may sever a vein or artery) or who are actively suicidal. In those instances, the primary goal of hospitalization is safety. Lengthy hospitalizations are often counterproductive.

Hope for Those With BPD

Some patients fear that a diagnosis of borderline personality disorder is akin to a death sentence. They’ve often been in the system long enough to understand the negative ramifications of such a diagnosis. This is unfortunate, because BPD is not something anyone chooses, any more than a person chooses to be schizophrenic, autistic or bipolar.  It’s not something a person can simply “control” if they just try hard enough.

If you or someone you love has (or suspect you have) BPD, reach out for help. Don’t let the fear of stigmatization get in the way of getting the help you deserve. A personality disorder is not a defect or weakness; it’s a psychiatric condition.  You deserve the same respect and compassion as anyone else suffering from any medical or mental health condition.

Be aware that treatment for BPD is often a lengthy process that requires a solid commitment. Therapy is not going to be brief, and miracles don’t happen overnight. But if you stick with it and enroll in a DBT program or work with a mental health professional who has a lot of experience in treating BPD, you can make significant positive changes in your life.

Treatment can help you learn to manage the intense emotions, fear of abandonment and other challenging symptoms. You deserve a bright future and a life filled with joy.