People who suffer from Borderline personality disorder (BPD) often struggle with extreme changes in mood, an intense fear of abandonment, and a harsh stigma surrounding them and their disorder. While the exact causes of Borderline personality disorder are unknown, many people who suffer from it report trauma in early childhood that can lead to an unstable self-image and feelings of emptiness. This disorder is often depicted in media such as Gone Girl to be manipulative and willing to do anything to keep a relationship. While people with BPD can be manipulative, this behavior often derived from their intense fear of abandonment. People with this disorder also suffer from masking, or taking on traits of others around them to fit in better, and splitting, or suddenly changing opinions of others due to black and white thinking. Other common symptoms tend to include self-harm or suicidal behaviors.
In order to be diagnosed with Borderline personality disorder, a patient has to have five or more of the following symptoms.
1. Frantic efforts to avoid abandonment whether real or imagined.
2. Pattern of unstable and intense personal relationships which are characterized by alternating between extremes of idealization and devaluation.
3. Markedly and persistently unstable self-image or sense of self.
4. Impulsivity in at least two areas that are potentially damaging such as spending, substance abuse, reckless driving, etc.
5. Recurrent suicidal behaviors, gestures, threats or self-harm.
6. Affective instability due to extreme reactivity of mood.
7. Chronic feelings of emptiness.
8. Intense or inappropriate anger or difficulty control said anger.
9. Switching between stress related paranoid mind set or severe disassociation.
Like many personality disorders, the exact causes for Borderline personality disorder aren’t well known. Some studies have shown that there may be a genetic link, making it estimated to be the third most inheritable personality disorder. It’s also heavily tied with childhood trauma, specifically an ongoing pattern of repeated abuse, with many patients reporting neglect and invalidation of their thoughts and feelings by caregivers in addition to the abuse. This coupled with not being able to form attachments at an early age can lead to the abandonment issues as well as splitting, or the difficulty perceiving that a person can have both positive and negative traits. People with BPD tend to view various people in their lives in a very positive or very negative light. How they view someone can change quickly and waver back and forth, which is why it’s called splitting. Studies have shown three family dynamics that lead to an increased chance of developing BPD: the chaotic family, the “perfect” family, and the “normal” family. As it sounds, the chaotic family is what we commonly associate with abusive families with obvious verbal, emotional, or physical abuse that leads to a chaotic household where a child never knows what’s going to happen next. The “perfect” and “normal” families are similar, with the “perfect” family simply being a more extreme case. In both of these, the parents insist that their family is perfect or normal, any arguments or feelings otherwise are invalidated, and the child is often gaslit into believing their abuse isn’t real.
One of the biggest issues when it comes to diagnosing Borderline personality disorder is the fact that many of the symptoms overlap with other disorders. One of the common disorders that BPD is misdiagnosed as is C-PTSD (Complex post-traumatic stress disorder), as both are trauma-based disorders. The other most common misdiagnosis is bipolar disorder due to the sudden changes in mood. Studies have shown that almost 40% of people who end up being diagnosed with BPD were first diagnosed with bipolar disorder. This misdiagnosis can cause a number of lasting issues for the patient, from side effects for medication they were incorrectly prescribed to years of therapy that doesn’t work from psychologists trying to treat the wrong disorder. This, coupled with the stigma that patients with BPD are high maintenance or harder to treat, means that some patients can go years without the correct treatment. For those who are diagnosed, therapy comes in the form of psychotherapy rather than medication. The most commonly used types of therapy to treat BPD are Cognitive Behavioral Therapy (CBT) and Dialectical Behavioral Therapy (DPT), the latter of which was actually created by a therapist who had BPD. As both of these types of therapy involves changing a person’s behavior and beliefs through identifying issues from the disorder, treatment can often take years of continued therapy but can be well worth it when learning to treat some of the more extreme BPD behaviors.
