– As much as a Victim as a Perpetrator.
In my opinion, this statement summarises the irony in a Borderline Personality Disorder person’s life. She or he is a victim of her or his own emotions. And as a fallout, they end up giving a lot of grief and torture to those around them.
Before I move further, I would like to say that we may believe that a BPD person will show no improvement. However, research says people can improve through a combination of therapy, medication, and emotional support. Awareness and a safe space in treatment for a person to face their fears, their emotions support healing. This blog has taken a compassionate and empathic approach for both the person afflicted with BPD and the members who deeply care about them.
What Is Borderline Personality Disorder?
When you hear BPD, what comes to you? I am sure you are reading this blog since you may be a victim of BPD or are concerned for someone you care for who is diagnosed with BPD or has BPD like symptoms.
BPD, as an illness, carries an intense stigma and a deep shame. Many times, it is referred to as the “leprosy of mental illnesses”. In my blog, I would like to talk about this most misunderstood psychiatric disorder of our age.
A borderline personality disorder is characterized by-
– Pervasive instability in moods
– Emotional dysregulation
– Negatively impacted interpersonal relationships
– Disruption of family and work-life
– Poor self-identity and self-image
A borderline personality disorder is vividly evident in the context of relationships. It takes a devastating toll on both people afflicted with BPD and their loved ones.
BPD person usually experiences wide mood-swings in a blink of an eye. The mood swings from feeling happy to extremely angry. A person diagnosed with BPD can be loving, fun, intimate, exciting, and the very next moment angry, sluggish, berating, abusive. It can disrupt and damage a person’s self-esteem as well as impact relationships.
On the one hand, we have the person diagnosed with Borderline Personality Disorder (BPD) going through their own eternal hell. On the other hand, we have traumatized family members who may start believing, “It’s my fault”.
According to the National Alliance on Mental Illness (NAMI, USA), around 1.4% of Americans suffer from Borderline Personality Disorder (BPD). BPD is the most common and most debilitating of all personality disorders.
How Is BPD Personality Different from a Normal Personality?
Our personality can describe each one of us—for example, a calm person, an angry person, a fun person and many more. Depending on the experiences and circumstances, most of us will shift from our usual personality. However, most of the time, we will stay stable over a long period. My personality is friendly, smiling, calm and nurturing. However, I can also get angry from time to time.
However, a person with BPD can experience pervasive, ongoing trouble with emotions, behaviours, thoughts, and relationships. BPD people usually suffer from a disorder of emotional dysregulation.
Looking From the Lens of a Person Suffering from BPD
Life for a BPD diagnosed person is not easy. There are days they may sit in a dark room or days when they may not utter a single word or constantly staying with the deep-rooted fear of abandonment that triggers anger and other emotions. A BPD person has anger, pain, resentment, and sadness as their constant companion.
A person may resort to medication or other addictions like alcohol, drugs, or eating binges as their way of releasing the soothing brain chemicals to manage their internal chaos and anguish. The damaging behaviours also help them to cope with their overwhelming sense of shame. However, the relief does not last long, and it rebounds stronger with feelings of self-hatred, shame and alienation.
Self-injury is another way for BPD person to feel a release from the pressure of their emotions even though it is momentary. Other common impulsive behaviours include.
– Impulsive spending
– Gambling
– Unsafe sex
– Suicidal Ideations and Attempts
– Rash driving
The very thing a BPD person fears the most – abandonment, becomes part of their daily pattern. Friends and family members want to avoid them. There is rejection awaiting them. The fear of abandonment over the years because of regularly experiencing it becomes far more terrifying than death. A BPD person may suffer from unrelenting loneliness.
People with BPD desperately want to have good relationships, but they repeatedly inadvertently sabotage their efforts to create and maintain positive relationships. A BPD person has an intense need to receive positive unconditional love, high nurturance and adoration. However, it’s never enough. And they resort to ridicule or rage as a coping mechanism for their intense disappointments.
Usually, their loved ones are confused about constantly meeting two contradictory personalities. A warm, enthusiastic and exciting BPD person full of love and care at the beginning of a relationship is now looking like a monster. Ultimately, things start going wrong, and a BPD person’s fear of abandonment is triggered. And like I mentioned, their coping mechanism may be to be angry, abusive, aloof, derisive, discounting the other person, and so much more.
Our brains have an internal emotional regulator, just like a vehicle braking system. It helps us to slow down on a rolling downhill and manage our emotions well. However, a BPD person has dysfunctional brake systems. The brake systems are similar to a golf cart, not adequate to handle the weight of the internal turmoil of the emotions. They act impulsively without thinking about the consequences of their actions.
Looking from the Lens of the Caring Member
Alright . . . what do you want me to say? Do you want me to say it’s funny, so you can contradict me and say it’s sad? Or do you want me to say it’s sad so you can turn around and say no, it’s funny. You can play that damn little game any way you want to, you know!
—From Who’s Afraid of Virginia Woolf? by Edward Albee
Does it sound familiar? Many caring members do not know how to respond to BPDs.
Dealing with borderline behaviour can be frustrating for everyone in regular contact with the borderline personality. As mentioned, BPD’s explosions of anger, rapid mood swings, suspiciousness, impulsive actions, unpredictable outbursts, self-destructive actions, and inconsistent communications are understandably upsetting to all around them.
My client stayed in a relationship with a person suffering from BPD for thirteen years, hoping to change her partner. Heartbroken, she walked out of her relationship with very low self-esteem, thinking, “It’s my fault”, “I am defective”. She did not have prior knowledge about BPD. She was relieved and finally started understanding that it was not her fault. The book ‘Stop Walking on Eggshells- Taking Your Life Back When Someone You Care About, Has Borderline Personality Disorder by Paul Mason and Randi Kreger, helped her with therapy to rebuild her confidence in herself.
Usually, a person in a relationship with BPDs can be confused as they see frequent shifts in BPDs from being loving to ripping in shreds in the very next moment. This quick change causes intense distress and trauma to loved ones.
The partner/ parent/ sibling and others will usually start to question their own behaviour and actions. “Did I do something wrong?” “Am I the cause of the problem?” And they begin to believe and accept that they are flawed, and everything is their fault.
Usually, a caring member will:
– witness major arguments in public places.
– suffer BPD’s anger for many days because he or she believed something to be true in their fantasy or dreams?
– receive veiled or explicit suicide threats.
– experience a great deal of pain caused by the very person they care about.
– fear the response from the person afflicted with BPD, and hence they fall in a pattern of hiding or concealing.
– make excuses for BPD’s reasons and convince themselves that everything is ok.
– notice that a BPD person will try anything to stop them, including promises to change and implicit and explicit threats.
– constantly receive advice to change their behaviours.
Partners are bewildered and hurt to hear damaging and embarrassing lies about themselves. Parents spend a lifetime and life savings, trying to help their children. Often, they are accused of child abuse. Adult children and siblings of BPD’s go through their own nightmares. One worry is about their children developing BPD.
What Are the Risk Factors That Can Lead to BPD?
No one has understood the exact cause of borderline personality disorder, but research is going on. Some researchers say that environmental factors like neglect or a history of child abuse may be the most worthwhile causes of borderline personality disorder. Some other reasons are:
1. Trauma:
A BPD person may have a history of past traumas. These traumas can include life events like a divorce, loss of a loved one, emotional neglect, abuse (physical, verbal, emotional and sexual), bullying, and others. It may include having feelings of being abandoned. For example, in divorce, a BPD may feel abandoned by his or her parents.
Studies on the effects of divorce typically report profound upset, neediness, regression, and acute separation anxiety related to fears of abandonment in children of preschool age.
Psychologically absent parents show little interest in the child’s development and provide no affection in times of need. As mentioned earlier, A BPD person has an unlimited appetite for unconditional love, nurtured, and validated. From a BPD diagnosed person’s frame of reference, there may be emotional neglect, not given a listening ear and feelings of being discounted as a person.
Lack of early emotional attention gives rise to intense restlessness and anxiety in search of emotional satisfaction. The need for affection is very high, and this severely impairs their ability to discriminate. For example, a BPD in a marriage or a relationship may still maintain sexual relationships outside this relationship with two or three or more people.
Majority of BPD sufferers will mention that their feelings were not validated in childhood.
3. Abandonment
Abandonment is one of the major fears that accompanies a BPD person throughout their life unless they opt for therapy. In today’s age, abandonment comes in many forms.
– Separation from their immediate relatives, grandparents because the family moves away, – divorce of parents
– Losing a loved one, especially parents
– Growing up with grandparents or other members instead of parents
– Moving homes and leaving behind loved ones or friends
– Spending more time on the internet rather than with people
4. Genetics:
A person is vulnerable to BPD if either of their parents suffers from it. However, treat this information with caution as there is no gene identified for BPD.
5. Biology
There is a specific portion of each aspect of our brain. Every area of the brain handles certain things like emotion, aggression, and impulsivity. People with BPD appear to have differences in how their brains work and how the neurons (neurotransmitters like Serotonin) in their brains communicate.
6. Brain Development
MRI studies of the brains indicate that many people with BPD may have smaller than expected brain parts or have unusual levels of activities in these brain parts:
– The amygdala
– The hippocampus
– The orbitofrontal cortex
Early childhood upbringing plays a significant role in brain development.
How Does BPD Impact A Person?
Now, what are the complications along with getting borderline personality disorder? A borderline personality disorder may impact multiple areas of a BPD’s life. It may affect their relationships, jobs, social activities, self-image, self-identity, careers, etc. Some of the impacted issues are as follows:
- A BPD may not be able to complete their desired education.
- There may be many job changes.
- BPD person may be embroiled in legal issues like going to jail many times, say for stealing.
- They usually suffer from continuous marital stress, divorce issues, and unstable relationships.
- A BPD may have self-harm tendencies like cutting, burning to cope with the internal turmoil of emotions.
- They may indulge in unhealthy and abusive relationships.
- There may be suicide ideations or an attempt to commit suicide.
- Uncontrolled and unsafe sexual activities.
- BPD is at a higher risk to get sexually transited infections.
- They may get into physical fights due to their rash and uncontrolled behaviour.
- A BPD with mood disorders are at a higher risk to be involved in a vehicle accident.
In addition to those mentioned above, they may also suffer from the following:
- Eating disorders.
- Depression.
- Anxiety disorders,
- Misuse of alcohol.
- Bipolar disorders.
- Attention deficit disorder.
- Hyperactivity disorders.
- Post-traumatic stress disorders (PTSD)
Why Is It Important To Diagnose BPD?
Borderline Personality Disorder is treatable, and there are practical and brief treatments available. Treatments give hope to all the people suffering from it or the loved ones who care for BPD person. Diagnosis of BPD plays a vital role to start the process of healing. It may cause shame, hatred, or doubt initially; however, it also helps bring awareness to themselves, which helps rebuild self-esteem and diminishes self-loathing. The correct diagnosis allows a person to take personal accountability and control of their life. I would recommend reading the book, Beyond Borderline, by John Gunderson to understand how diagnosis helped people recover from BPD.
How To Diagnose BPD?
It is advisable not to diagnose BPD yourself. Please consult a psychiatrist for a detailed diagnosis. Diagnosis of BPD by a psychiatrist will include a thorough assessment of:
– Medical history
– Family history
– Childhood history
– Current signs and symptoms
– Personality-based questionnaire
– Any other information as required by the doctor
What Can You Do If You or Your Loved Ones Have Suicidal Thoughts?
It is not uncommon to have suicidal ideations or thoughts when BPD suffering is in severe distress. You can take a few steps immediately.
– Connect with Samaritans of Singapore – Call their 24-hour hotline 1800-2214444
– Contact Institute of Mental Health (IMH), Singapore – Call their 24-hour hotline 63892000
– Contact Singapore Police to ask for help – Call 999
Please look for your country’s emergency contact details and keep them handy.
– Make an appointment to meet your doctor or mental health provider.
– Reach out for support to a loved one, trusted friends and peers.
– Reach out to your religious community.
What Are the Treatments For BPD?
In the past, there were not enough guidelines and research to treat borderline personality disorder, and people considered BPD as a non-treatable disorder. However, that is no longer true. With continuous research, there are new effective treatments for BPD.
1. Psychodynamic Therapy like Transactional Analysis
A psychotherapist in a safe and non-judgmental environment builds a trusting and therapeutic relationship with their client. The psychodynamic therapist focuses on the unconscious processes that originate in early childhood and disrupts the present. A BPD person can talk about their life experiences and explore their emotional difficulties with themselves and their relationships. It helps them rationalize and sort their inner thoughts and emotional turmoil’s. They can reflect with a new insight.
2. Eye Movement Desensitisation and Reprocessing (EMDR)
EMDR is an evidence-based therapy researched to work very well with traumas. It is not uncommon for a BPD person to have early traumatic and adverse life experience in their early childhood and teenage years that contribute to their BPD. The traumas experienced may be everyday verbal abuses, physical abuses or traumas around abandonment, sexual abuse, etc. EMDR helps a person to process and heal from traumas. It allows a BPD person to process and heal their past traumas to move forward in their present and future healthily. Do connect with us now to find out more.
3. Dialectical Behaviour Therapy (DBT)
DBT is a form of Cognitive Behaviour Therapy that helps a client live in the here and now. It helps a client in regulating their emotions and healing from destructive behaviours.
4. Mentalization-based therapy (MBT)
MBT therapy can understand actions by both other people and oneself regarding thoughts, feelings, wishes, and desires. Mentalisation techniques are one of the choice theories to use with BPD persons. Mentalizing involves an awareness of mental states in oneself or other people, particularly when it comes to explaining behaviour.
Some other therapies are:
- Art therapy
- Drama therapy
- Dance movement therapy
- Music therapy
The Bottom Line
– BPD person can cause havoc in their own lives and the lives of others.
– A person in a relationship with a BPD finds it challenging to be in this relationship
– BPDs usually have an intense fear of abandonment
– Borderline Personality Disorder is treatable.
– There are practical and brief treatments available.
– BPD treatment helps to rebuild a positive image for themselves and diminish self-loathing.
