Friends, this is the second entry in a series about personality disorders. I want to give it the attention it needs in order to really cover the topic. I am splitting this into two entries. This one will talk about the symptoms of Borderline Personality Disorder (BPD). My next entry will discuss treatment, and advice for loved ones.
There are several theories about the origins of BPD. I am going to share one with you, but I need to make something clear: It is extremely important not to assign blame for a diagnosis. It's a really easy trap to fall into, but it's also not productive. My purpose for sharing this theory is to help my readers understand where some of the symptoms of BPD may come from, and how a person with the disorder may feel. So, having said that, I want to share with you one that makes sense to me: Remember when we were discussing Erik Erikson, and his developmental stages? The very first one, from birth to about 9 months, is Trust versus Mistrust. When we are in this stage, we are completely dependent on our caregiver. However, the only method we have to communicate is to cry. We typically only cry when we are experiencing some kind of distress: hungry, wet, tired, hurt, you get the idea. What usually happens once we start crying is that somebody comes and figures out what we need, and meets that need. What we learn from this is that we are safe, and when we express a need, it's going to be met. Even when we face challenges and difficult feelings, we develop a sense of security that things are basically going to be okay. It therefore makes sense that the virtue we develop is hope.
So what happens when we cry and nobody comes? The world is apparently not safe. We can't rely on anyone to meet our needs. People are not trustworthy. But not being able to trust anyone doesn't make the need go away. We still want to be picked up and cuddled and fed. If the baby doesn't develop trust at this stage, what they are left with is fear. When we start at the diagnostic criteria, try to think about how fear drives the emotions and reactions of a person with BPD. Let's also remember that a person has to successfully resolve one stage in order to move on to the next. If someone gets stuck at the very first one, life is going to be very challenging. While they may develop coping strategies for various situations, the underlying personality is still there. They're not set up to develop autonomy, which makes it difficult to maintain a separate identity in relationships. Initiative, competency, identity, and intimacy are the values we should be learning as we go through childhood, adolescence, and young adulthood.
So keeping this in mind, let’s take a look at the symptoms:
According to the DSM 5, the diagnostic criteria for Borderline Personality Disorder states that a person must have “A pervasive pattern of instability of interpersonal relationships, self-image, and affects, and marked impulsivity, beginning in early adulthood and present in a variety of contexts, as indicated by five (or more) of the following:
1. “Frantic efforts to avoid real or imagined abandonment. (Note: Do not include suicidal or self-mutilating behavior covered in Criterion 5.)” A person with BPD is constantly in fear of losing significant relationships. They may feel extremely vulnerable in these relationships, since trust is never fully developed. We’ll discuss more about the intensity of a person with BPD’s feelings when we get to criterion 6.
2. “A pattern of unstable and intense interpersonal relationships characterized by alternating between extremes of idealization and devaluation.” One of the leading books written about BPD is called, “I Hate You, Don’t Leave Me.” This characterizes relationships in a person with this disorder’s life extremely well. Relationships are all good, or all bad. A person with this disorder will feel the need to have proof of the other person’s commitment to them. They will obtain it by pushing someone away, which reinforces their internal lack of self worth. Soon after, however, they will need the other person to prove that they would never really leave for good. The person will then idealize the one they recently pushed away in order to win them back and keep them close.
3. “Identity disturbance: markedly and persistently unstable self image or sense of self.” A person with BPD may love themselves one day, and hate themselves the next. Facts aren’t important in making judgements; emotions are. The black and white thinking about relationships with others also applies to the person’s feelings about themselves. When you add to this the fact that the person’s feelings are all or nothing, it becomes a really difficult way to live in their own skin 24/7.
4. “Impulsivity in at least two areas that are potentially self-damaging (e.g., spending, sex, substance abuse, reckless driving, binge eating). Note: Do not include suicidal or self-mutilating behavior covered in Criterion 5.” Let’s define impulsivity as acting or speaking based on feelings, without applying logic and reason. It’s easy to see how not thinking through a decision based solely on emotion could be problematic. Again, a person with BPD experiences strong emotions. When we look at a person with strong emotions combined with impulsivity, it becomes easier to see how they would be prone to these behaviors.
5. “Recurrent suicidal behavior, gestures, or threats, or self-mutilating
behavior.” Borderline Personality Disorder is a very difficult disorder to have and to manage. Feelings are intense. Relationships are both wonderful and horrible, even relationships the person desires and values. There are incidences of self-harm which are not meant to be suicidal. However, it is not unheard of for an incident that was only meant to be one of self-harm to be fatal. Someone with BPD may engage in self-harm because they want to feel physical pain to distract themselves from emotional pain. Another person, also having BPD, may do it because they feel numb, and want to feel “something.” It may be to feel a sense of control over one’s body. It can also be a form of self-punishment.
6. “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).” Something to understand is that many people with BPD describe their experience of their emotions as quite strong. It may seem like the person is blowing things out of proportion. But remember, everyone’s experience of any given situation is going to differ. Think of people without BPD as having emotions on a dimmer switch. Someone with this disorder is wired differently, with only an on/off switch.
7. “Chronic feelings of emptiness.” These empty feelings contribute to the intensity of relationships a person with BPD has with other people. They are unable to meet their own emotional needs, and rely on others fulfill them. The person may feel worthless outside of their relationships with others. These feelings of emptiness are intense, just like the person’s other feelings. Therefore they contribute to the other criteria like relationships, risk taking, and self-harming behaviors.
8. “Inappropriate, intense anger or difficulty controlling anger (e.g., frequent displays of temper, constant anger, recurrent physical fights).” Anger is like any other emotion the person experiences: intense! It’s important to remember that there is no gray area in a person with BPD’s thinking. Statements using “always” and “never” are common in arguments. This is how the person experiences the world: always in absolutes. The person may also bait others into arguing with them. This is a way the person combats the chronic feelings of emptiness. Arguments with a person with BPD often result in a no-win situation, and can be very hurtful. Remember criterion 2 when the person with BPD was pushing you away to see if you’d still come back? Lashing out in anger is a prime example of how they may accomplish this.
9. “Transient, stress-related paranoid ideation or severe dissociative symptoms.” This is another symptom that comes from making decisions and judgments based only on emotion without considering facts. What it may look like is that the person with BPD will remember an event that never happened, or not be able to remember another event that did happen. Most people are able to alter their thinking to take in new information. A person with BPD alters the information to fit with their thoughts. In this way, they are able to alter events in their mind, contradict their own story, and ignore facts, even when confronted with them. This type of thinking is also how the complete idealization and devaluation takes place. The person will change the information they have to fit how they feel about someone or something.
(American Psychiatric Association, 2013)
People with personality disorders rarely seek treatment. This is because they view the world and the people around them as needing to change, but not themselves. There are, however, treatment models which are effective in helping someone with BPD manage. I’m going to split this entry up into two, and write about treatment, and also how friends and family of someone with Borderline Personality Disorder can engage with the person, and keep themselves safe.