Understanding Borderline Personality Disorder

Borderline personality disorder (BPD) is a mental health condition that affects around two percent of Americans. The disorder affects women three times more often than men. It can be the cause of broken relationships, difficulty with employment and a higher than average risk for self-harm.

BPD is an illness of extremes. It’s characterized by a poor self-concept, an intense fear of abandonment, being alone, an overwhelming sense of emptiness, extreme moodiness, tumultuous relationships, impulsive behavior and risk of suicide. The person with BPD is also at high risk for self-harm like cutting, burning or scratching because they would prefer to feel anything other than empty.

The person with BPD has a difficult time managing the unpleasant emotions that are part and parcel of all relationships. They may understand intellectually that they exist, but when they must handle them, they find themselves incapable.

Common Symptoms – Exaggerated and Sustained Over Time

  • Tumultuous relationships
  • Low self-image
  • Self-injury
  • Impulsivity
  • Severe and swift mood changes including explosive anger
  • Fear of being abandoned
  • Overwhelming sense of emptiness
  • Temporary distortions of reality when stressed
  • Suicidal ideation or attempt

One problem for this person is a habit of gross misperception. When they feel overly-stressed they are vulnerable to misreading non-verbal cues and inflating the emotions of others in a way that can be described as psychotic. The other person may be mildly irritated, but the person with BPD reads it as anger or hatred. This creates obvious challenges to relationships.

The fear of abandonment and rejection is so compelling that a person with BPD can feel alone even when they are in the midst of a close relationship. The highs and lows which are part of all relationships are cause for panic to the one with BPD. To quell the fear, the person may act rashly perhaps even going so far as to harm themselves.

But it isn’t just that the person with this disorder believes the worst about others, sometimes they believe a fairy-tale version of others that is unrealistically idyllic. So much of the disorder has to do with extremes. They may create a romanticized idea of someone important to them. And since no one can actually live up to that ideal, disappointment is inevitable. But this too will be over-the-top. The formerly idealized person is faulted for being imperfect rather than realizing that expectations were unrealistic to begin with.

Most mental health professionals believe that BPD is the result of a combination of environmental and biological factors. Problems in early childhood such as neglect, abuse or trauma are common among those who have the disorder. Similarly, research has indicated that people with BPD have difficulty regulating mood and coping with stress almost from the day they are born.

Other physiological traits associated with BPD are a heightened startle response, irregularities in the immune system and distinct hormonal patterns. Yet there is no biological test to determine whether or not a person has the condition.

The Benefits of Treatment

Although the symptoms of BPD are often personal traits that will always be something of a challenge, treatment usually leads to great improvement. A 2006 study showed that cognitive behavioral therapy leads to greatly reduced suicidal acts, hospitalizations and accidents.

Dialectical behavior therapy has also shown greatest success in dealing with this disorder. The therapy utilizes individual and group settings, and has been shown to reduce anxiety, depression, suicide and self-harm among patients.

Schema therapy focuses on the maladaptive thought patterns and world outlooks patients filter through, helping them to develop healthier and more realistic worldviews.

Transference therapy has worked well in terms of helping patients to see that different people have different perspectives. This inability to differentiate is a constant source of relational frustration for people with BPD. The therapy has been shown to be more useful than dialectical behavior therapy in terms of lowering impulsivity, irritability and aggression.

With any of the above therapies, mood stabilizers or anxiety medications may also be recommended. Sometimes these help patients to control anger problems and overcome fear-driven behaviors. The bottom line is that if a person with BPD will stick with therapy, there is much hope.