Breaking the Stigma: Understanding Borderline Personality Disorder (BPD)
Table of Contents:
TW: BPD, Self-harm, Suicide
Borderline Personality Disorder (BPD) can be largely misunderstood, and therefore stigmatised. It is therefore important to clarify what Borderline Personality Disorder is; to provide reliable information that can counteract many of the untruths that are perpetuated in social media, articles and private conversations. In this article, we will define BPD according to the The Diagnostic and Statistical Manual of Mental Disorders (Fifth Edition) and Psychodynamic theory; explain what BPD is not; share some personal experiences of individuals diagnosed with BPD, and offer some guidance for treatment options.
Art by Nikkita Morgan.
I was inspired to create a personal story regarding my Borderline Personality Disorder, as this is offer not heard about. The aim of my embroidered story was to highlight and encourage others to openly talk about mental health issues.
“People with borderline personality disorder (and those like them) are like people with third-degree burns over 90% of their bodies. Lacking emotional skin, they feel agony at the slightest touch or movement”.
Marsha Linehan, creator of Dialectical Behavioural Therapy for BPD.
People diagnosed with BPD often struggle with intense emotions that can be difficult to manage. These emotions can feel like burning pain that never goes away.
Similar to how third-degree burns require specialised treatment, BPD often requires specialised therapy to heal. With time and effort, it is possible to recover from BPD and find ways to manage intense emotions. It's important to seek help from an experienced mental health professional – just as it's important to seek medical attention for severe burns.
What is Borderline Personality Disorder?
Borderline Personality Disorder is a mental health condition characterised by pervasive instability in mood, behaviour, self-image, and interpersonal relationships. People diagnosed with BPD experience intense emotions, have difficulty regulating them, and can engage in impulsive behaviours that may have negative consequences. It is estimated that 1-2% of the general population may experience BPD.
In the field of psychology, the term "borderline" has two different meanings. The original definition was coined by psychoanalysts; the second, more official meaning of borderline comes from the DSM, a diagnostic manual used by mental health professionals.
What is BPD according to the DSM-5?
The Diagnostic and Statistical Manual of Mental Disorders (DSM) is a reference book used to classify mental health and brain-related disorders and conditions. According to this manual, Borderline Personality Disorder (BPD) is characterised by unstable relationships, self-image, and emotions, as well as impulsive behaviour that usually starts in early adulthood and occurs in various situations. A diagnosis of BPD requires meeting at least five of the nine symptoms listed below:
Frantic efforts to avoid real or imagined abandonment.
A pattern of unstable and intense interpersonal relationships characterised by alternating between extremes of idealisation and devaluation.
Identity disturbance: markedly and persistently unstable self-image or sense of self.
Impulsivity in at least two areas that are potentially self-damaging (e.g., spending, sex, substance abuse, reckless driving, binge eating).
Recurrent suicidal behavior, gestures, or threats, or self-mutilating behavior.
Affective instability due to a marked reactivity of mood (e.g., intense episodic dysphoria, irritability, or anxiety usually lasting a few hours and only rarely more than a few days).
Chronic feelings of emptiness.
Inappropriate, intense anger or difficulty controlling anger (e.g., frequent displays of temper, constant anger, recurrent physical fights).
Transient, stress-related paranoid ideation or severe dissociative symptoms.
To be diagnosed with BPD, an individual must have five or more of these symptoms, which must be present for a significant amount of time and must cause distress or impairment in social, occupational, or other important areas of functioning.
Please keep in mind that only a trained professional can diagnose an individual using the criteria above. If you feel identified with some of the symptoms above, please get in touch with a mental health practitioner.
If you are having suicidal thoughts, contact the National Suicide Prevention Lifeline at 988 for support and assistance from a trained counsellor. If you or a loved one are in immediate danger, call 999.
What is Borderline According to Psychodynamic Theory?
In psychodynamic theory, the term borderline comes from a spectrum used to describe the three levels of personality organisation. It was first used in 1938 by psychoanalyst Adolf Stern to describe patients who were “bordering” or in between two levels of personality organisation. Within this spectrum, there is neurotic on one end, and psychotic on the other; with borderline in between.
Neurotic patients are those who have anxiety or other forms of emotional distress but can function relatively well in daily life. Borderline patients have more severe emotional regulation problems, as well as instability in their relationships and sense of self. Psychotic patients experience detachment from reality and often have delusions or hallucinations.
The borderline category falls somewhere in between neurotic and psychotic, both in terms of symptom severity and the underlying psychological structure.
Psychodynamic theory posits that BPD is caused by a combination of genetic and environmental factors, particularly childhood trauma and invalidating environments. According to psychodynamic theory, individuals with BPD have a heightened sensitivity to emotional cues, which can lead to intense emotions and difficulty regulating them. Furthermore, individuals with BPD may have a fragile sense of self, which can make them more vulnerable to extreme changes in their self-image and identity. This can also lead to a heightened fear of abandonment and rejection, which may explain some of the interpersonal difficulties associated with BPD.
Personal Stories of BPD
“I created this picture when I was feeling really down and depressed, with no sense of direction and sense of being. I wanted a visual representation of how some of the BPD symptoms can make me feel. Empty. Distorted. Alone. Unrecognizable. Depressed. I want to people to understand the reality of this disorder, but I’m too afraid to share it sometimes. I don’t want to seem attention seeking, exaggerating or negative. But this is truly the reality of the disorder, and I should be able to speak of it without stigma.” — Kellyann N.
Laura, 21
“I felt ashamed and abnormal when I would feel certain things: such as feeling suicidal over seemingly trivial events or interactions. Some days, I didn’t feel real: believing that the emptiness of being so unwell had consumed all of me so much so that there wasn’t even really a true ‘me’ anymore. I desperately wished I could undo all of it; but every day was a drop deeper than the last, and it happened so suddenly.
I never spoke about the details of what I felt, and never thought I would. I worried about how it would look and how far people would drift from me, because if it didn’t even make sense to me, how could it make sense to anybody else?”
Rachel Reiland
“I couldn’t trust my own emotions. Which emotional reactions were justified, if any? And which ones were tainted by the mental illness of BPD? I found myself fiercely guarding and limiting my emotional reactions, chastising myself for possible distortions and motivations. People who had known me years ago would barely recognize me now. I had become quiet and withdrawn in social settings, no longer the life of the party. After all, how could I know if my boisterous humor were spontaneous or just a borderline desire to be the center of attention? I could no longer trust any of my heart felt beliefs and opinions on politics, religion, or life. The debate queen had withered. I found myself looking at every single side of an issue unable to come to any conclusions for fear they might be tainted. My lifelong ability to be assertive had turned into a constant state of passivity.”
– From Get Me Out of Here: My Recovery from Borderline Personality Disorder
Shae Maree
“What I learnt from the doctors I spoke to was that BPD was a dirty diagnosis, and no doctor wanted to ‘label’ their patient with it.
I don’t see it as that, though I can’t say I never think of it that way. My diagnosis makes things very hard for me. I struggle with day to day things, from doing my own washing to feeding myself. I’m not always this bad, but I can be. Sometimes I don’t sleep because I’m so consumed with stress and depression over things that may not even happen. When I become stressed I often begin to hear things; this scared me a lot the first time, and when it gets really bad I’m terrified. Making friends is really hard for me as I often tell too many personal details too fast. Sometimes I worry that I look like I’m attention seeking – I’m not, I just get so stressed in social interactions that I can’t stop myself from bringing up whatever upsetting thing that I think of. I come away from those interactions feeling awful and guilty, then comes the inevitable two page apology note that I send the person, and if I haven’t scared them off by then, I’m lucky.”
Anonymous
“I was diagnosed with BPD about seven years ago. When I was told what it was, I went home and researched everything I could about it. I was excited because all of my problems finally had an explanation, and just maybe I wasn’t such a bad person. Maybe it wasn’t all my fault like I was always told and I always believed. And most importantly, maybe I had a chance to get better.
Unfortunately, a few years later, the societal stigma against mental illness reared its ugly head. People started telling me that I was using my diagnosis as an excuse for my bad behavior. I started to believe that. It’s like every step I had ever taken to better myself since my diagnosis, just never happened. All the feelings of worthlessness came flooding back into my head. I quit writing. And it felt like nothing I could ever do to try to improve myself would ever matter to the people I cared for, because of everything that had happened in my past.”
What BPD is NOT – the Myths
BPD has been stigmatised by the media, the medical community, and even by mental health professionals. Many people with BPD are seen as manipulative, attention-seeking, and difficult to treat. This prejudice can make it difficult for people with BPD to seek help, and it can also lead to inadequate or inappropriate treatment.
One reason for this stigma is that the symptoms of BPD can be challenging for untrained mental health professionals to treat. However, with the right treatment and support, people with BPD can manage their symptoms and lead fulfilling lives.
Debunking Myths about BPD
There are several myths about BPD that contribute to the stigma surrounding this condition. Here are some of the most common myths and the truth behind them:
Art by Isabel Malia
“I Create Chilling Art To Bring Awareness To Borderline Personality Disorder”
Myth #1: Borderline personality disorder is untreatable
Many people assume that BPD is untreatable, but this is not the case. While BPD can be a challenging disorder to treat, with appropriate treatment, people with BPD can experience significant improvement in their symptoms and lead fulfilling lives. The most effective treatment for BPD is dialectical behavior therapy (DBT), a type of psychotherapy that teaches individuals skills to manage their emotions, improve their relationships, and increase their ability to tolerate distress. Other types of therapy, such as cognitive-behavioral therapy (CBT) and psychodynamic therapy, can also be helpful. Medications may also be used to manage specific symptoms of BPD, such as depression or anxiety.
Myth #2: People with BPD are manipulative and attention-seeking
People with BPD are often accused of being manipulative and attention-seeking. While it is true that individuals with BPD may struggle with regulating their emotions and may engage in impulsive behaviors in an attempt to feel better, it is not fair or accurate to label them as manipulative or attention-seeking. It is important to remember that individuals with BPD are often in a great deal of emotional pain and may resort to extreme behaviors as a way to cope. It is important to keep in mind that everyone is doing the best they can given the skills they have. Additionally, the behaviours associated with BPD are not intentional, but rather a result of the individual's underlying emotional dysregulation.
Myth #3: BPD is a rare disorder that only affects women
BPD is often associated with women, but this is a myth. While women are diagnosed with BPD more frequently than men, this may be due in part to the fact that women are more likely to seek treatment for mental health issues. BPD affects both men and women equally, and the symptoms of the disorder can be just as severe for men as they are for women. It is important to recognise that BPD is not a gender-specific disorder and to seek treatment regardless of one's gender identity.
Can BPD be Treated?
Yes, BPD can be treated. In fact, research has shown that early intervention and appropriate treatment can significantly improve the prognosis of individuals with BPD. The most effective treatment for BPD is Dialectical Behavior Therapy (DBT), a type of cognitive-behavioral therapy that focuses on teaching individuals skills to manage their emotions, improve their interpersonal relationships, and reduce impulsive behaviors.
DBT includes four main components: individual therapy, group skills training, phone coaching, and therapist consultation team. During individual therapy, the client works one-on-one with a trained DBT therapist to identify and change negative patterns of behaviour, thoughts, and emotions. Group skills training provides an opportunity for individuals to learn new coping strategies and practice them in a supportive environment with others who are also learning the same skills. Phone coaching allows individuals to receive support and guidance outside of therapy sessions, and therapist consultation team helps the therapist to provide the most effective treatment for their client.
Research has shown that DBT is an effective treatment for BPD, with significant reductions in suicide attempts, hospitalisations, and other problem behaviours. Additionally, individuals who complete DBT have been shown to have significant improvements in their overall quality of life, interpersonal relationships, and emotion regulation.
If you or a loved one is struggling with BPD, it's important to seek professional help. A trained mental health professional can provide an accurate diagnosis and recommend appropriate treatment options, including DBT. With the right treatment, individuals with BPD can learn to manage their symptoms and lead fulfilling lives.
If you are interested in learning more about how DBT can help with BPD or to schedule a free consultation with a mental health professional, please contact us today.
Conclusion
Borderline personality disorder is a complex mental health condition that can be difficult to diagnose and treat. Despite the myths and stigma surrounding the disorder, individuals with BPD can experience significant improvement in their symptoms with appropriate treatment. It is important for mental health professionals and society as a whole to recognize the challenges faced by individuals with BPD and to provide the support and resources necessary for recovery. With increased awareness and understanding of the disorder, individuals with BPD can receive the compassionate care they deserve and live fulfilling lives.
AUTHOR
Raquel Ortega
DBT Therapist & Founder of Step Into Yourself
