People with borderline personality disorder (BPD) experience extreme changes in their feelings, mood, behavior and are unbalanced in maintaining a self image and relationships.
BPD is also sometimes referred to as Unstable Personality Disorder or Emotion Regulation Personality Disorder.
BPD often develops between the ages of 18 and 25, particularly in women. It’s difficult to predict who may be predisposed to develop BPD. As there is a hereditary component involved, chances are greater that you might develop it if there’s a family history of BPD. Along with this, it’s often thought that a disrupted parent-child relationship can be a determining factor. When a child does not feel safe whist growing up, separation anxiety or an attachment disorder can develop at an early age which then makes the child vulnerable to developing BPD later in life.
It can be said that the skills that are required to regulate emotions are underdeveloped in someone with BPD.
The behavior of people with BPD is unpredictable and they tend to perform below their ability levels. While not always the case, they may also self-harm, for example, by cutting themselves. This could be a cry for help, an expression of powerlessness or an attempt to desensitize themselves to overwhelming or painful emotions. It can also be used as a form of manipulation to frighten people around them into giving them more attention. Since people with BPD feel very dependent and, at the same time, can behave in a hostile manner, their relationships are often troubled. They sometimes throw themselves into short term relationships, are unfaithful and put excessive trust in someone they barely know. They can sometimes also be uncertain of their sexual preference. Obsessions with romantic partners or material things they desire occur frequently.
People with BPD often feel empty inside and have difficulty answering the question: ‘Who am I?’. They literally feel that their identity diffuses with that of someone else. Instantly they regard someone else as being loving and caring, or as the enemy and threatening, frequently changing relationships with people they trust and confide in. They view people as being good or bad and think in terms of black and white, also known as splitting. They can experience episodes of paranoia as well as dream-like states called dissociations. In spite of the fact that there’s awareness of what’s happening during these periods, there’s a sense of not being part of the world. At moments like these, one can be inclined to self-harm, which can then trigger dissociation. Everything is aimed to ‘not having to be present’, not having to feel anything. While others might think that the person is on the verge of attempting suicide, this might not at all be the case. On the other hand, suicidal thoughts can be present from time to time and caution should always be taken.
When someone is impulsive and unpredictable, it could indicate that something else is going on. People with BPD sometimes only let you see part of their life. By the time you find out about their other ‘parts’ it’s usually too late as the relationship has stranded. They are reluctant to admit that they feel chronically empty. Nor will they let you know that they may have recently confided in someone only to abruptly drop them. However, what is noticeable, is that when you ask them a direct question, you receive an honest answer. People with BPD usually aren’t very good liars, however, they can be extremely unwilling and avoiding when you ask for an honest answer. While they highly value trust and honesty, they are generally unable to live up to the standards they set. They often consider themselves to be worthless, stupid and ugly, even though they wouldn’t readily admit it. They can also be suddenly and briefly full of self-confidence, for example, when they just bought a pair of hip new shoes. By obtaining the ‘right’ things, they hope to gain attention or acceptance from others or fill their inner emptiness.
Sometimes a person doesn’t show up somewhere without giving any notice, causing you to worry about them. Afterwards you might have the unpleasant feeling that in some way it was all intentional. You can feel you’ve been manipulated, but have to be careful about saying it because that can cause someone with BPS to feel insulted and rejected. This is an important feature: They feel extremely offended by criticism and are fearful of being rejected and abandoned.
A person with BPD is often in a state of crisis. Their moods swing between sad, empty, argumentative and irritable. There can be short periods during which they lose their grip on reality. They go through long periods of feeling empty inside, not really knowing what to do with their lives, having doubts about their sexual preference and not knowing if they are able to trust their friends. In these circumstances, it may be very likely that you are dealing with someone with BPD. Other indications can be abuse of drugs or alcohol, extreme spending, over-eating, sexual promiscuity and other harmful behaviors. Parents, children and partners are often on the verge of exhaustion due to sleepless nights, constantly coming to the rescue and the negative atmosphere in the home.
The difficult thing is that these problems often occur during adolescence -are just part of a phase- and disappear as children grow up. This makes it difficult for parents to know if it merely goes with the age or if there’s something more serious going on. A diagnostic personality test by a qualified professional can give a definite answer. A diagnosis can give clarity about where factors related to upbringing end and the disorder begins.
What parents need to keep in mind is that extreme behavior is never healthy and cannot be maintained. Help is needed, for the person displaying these behaviors, as well as for those around them. Borderliners are very debilitated by their own behavior, but it can also be very damaging to others. It’s very painful when a person with BPD is largely dependent on you and you help that person however you can only to be harshly rejected. It can feel totally unjust. People with BPD often verbally abuse those around them. Due to their inability to deal with their emotions, they react by taking out their frustrations on others.
In as far as possible, it’s advisable to hold a person with BPD accountable for their own actions, including the negative consequences of them. This is the only way that someone can understand the importance of learning how to change their behavior. Among other treatments, BPD can be managed through psycho-education and learning how to use a preventive plan to give a person with BPD a way of dealing with it. Alongside that, additional support by means of medication may also be necessary.
Fairness is something that’s very important to someone with BPD and he/she can go to extremes in testing fairness with statements like, ‘If you can’t do this for me, then what does our friendship mean?’. You should always try to avoid making any promise you can’t keep. Criticism and minor disappointments can be interpreted as major rejection. You can try to avoid misery simply by leaving the person alone or only giving your opinion when asked. Sooner or later, however, things will go wrong, which is one of the features of BPD. Things go wrong in trusting and intimate relationships. They are unable to keep up long term relationships as their romantic partners will quickly tire of all the changing moods and manipulations. Their fear of abandonment then creates the very situation that they are afraid of.
Furious accusations, never wanting to see you again, walking away, blaming themselves or you which makes you powerless to make things better can all be expected when dealing with someone with BPD. Remaining true to yourself, not letting yourself be baited into angered reactions or walking away calls for a great deal of stamina and patience. After years of picking up the pieces, saving the day and taking deep breaths, it becomes impossible to keep supporting them because it has led to complete exhaustion.
Help with borderline treatment
There are specialized group treatments for people with BPD. In particular, patients from broken families or violent home environments where there is no one to rely on can benefit from interaction with group members and experienced therapists by being given experiences that teach them that things can be different. This form of treatment can sometimes take up to a year and then be continued with the support of part-time treatment. Almost all GGZ (Mental Health Care) organizations provide help with BPD.
The approach used in my practice for people with BPD consists of 4 steps:
Step 1: Insight through therapy
When there’s repeated problematic behavior in the interaction with me and the client does something which is typical of that, I let them know and say what I think about it, for example: ‘By reacting like that, you’re now creating a conflict with me.’ By receiving this kind of feedback, people can learn to recognize patterns in their behavior.
Step 2: Build a solid relationship
Clients should place so much value on their contact with me that they stay with me, even though confrontations may sometimes cause anger. When they leave in anger, they’re doing what they’ve always done, which is exactly what we want to overcome. I then let them know how much I appreciate and value it when they choose to stay and try to begin to break this pattern.
Step 3: Learning to take responsibility
I try to make clients aware of their choices in life, that there are certain things they have control over and, in doing so, encourage them to take responsibility for their choices.
Step 4: Acknowledgement
The client must acknowledge that he/she displays borderline behavior and recognize the problem. This also means that someone realizes and recognizes that he/she is a burden to or manipulates others. It is a huge triumph when someone does realize this! Then we can really begin to work on motivation and strategies for changing the behavior.
Symptoms of BPD can sometimes resemble those of psychological trauma. A disturbing event or something that took place during early childhood can result in extreme emotional instability or chronic traumatization. You find yourself on an emotional rollercoaster, feel unbalanced, are easily startled, vulnerable to addictions, feel stressed, exhausted, depressed and feel incapable of maintaining stable relationships. These are indications that you may have developed Post Traumatic Stress Disorder (PTSD) or Complex Post Traumatic Stress Disordering (C-PTSD). Before a diagnosis can be made, it is important to go back and think about what may have taken place in the past, such as abuse. Once that has been done, an appropriate form of therapy can be chosen. It is fairly common that cognitive behavioral therapy is advised rather than a more suitable trauma processing therapy. This often results in there being only a minimal and temporary effect which causes disappointment and delays the recovery process. It can take some time before you succeed in finding the right kind of help for you, but it is definitely out there.
The therapy I offer in my practice is for people with BPD, family members and partners of people with BPD and also provides help for people with PTSD or C-PTSD.