What is Borderline Personality Disorder?

A quick summary about Borderline Personality Disorder, or BPD, one of the many personality trait-based DSM diagnoses. In this video I try to show some of the difficulties of living with BPD, as well as a bit about treatment of the condition.

Questions and corrections always welcome in the comments.

For those interested in the DSM classification, I've left out two diagnostic elements in this video - dissociation/paranoia, and suicidal/self harm behaviours.

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What is Borderline Personality Disorder?

It’s estimated that one in a hundred people have borderline personality disorder, or BPD. In this video, we’ll talk about the challenges people with BPD face, the features that characterise the condition, and how people can recover from it.

People with BPD face issues such as
Feeling a desperate and urgent need to avoid being abandoned by other people - even if the abandonment is only imagined
Having intense and unstable relationships, repeatedly
Idealising people, then intensely disliking or devaluing them, in relatively short intervals
A chronic feeling of emptiness
Uncertainty of self - what psychiatrists call an ‘unstable self-image’
Repeatedly acting in impulsive and risky ways
Feeling rapid fluctuations in mood

To add to these challenges, BPD is currently under-recognised, and the availability of specific services is limited. The reason may include the social stigma of mental health conditions, or the challenges that health professionals face in treating BPD.

Think of these factors, then consider how that might affect a relationship between a health professional and a person with BPD.

If you know or have known someone with BPD, you might struggle to find empathy towards them. You might have good reason - they might have hurt you. It’s important not to blame the person in such situations. It’s not their fault, after all. So what is the cause of BPD? Well, it isn’t fully understood. Currently, a combination of biological factors and early-life experiences, such as trauma, is thought to contribute to the development of BPD.

Diagnosis
The psychiatrist’s manual of diagnosis - the DSM - encourages diagnosis of personality disorders based on the following:
An enduring pattern of inner experience and behaviour that deviates markedly from the expectations of the individual's culture, manifested in two (or more) of the following areas:
- cognition (i.e. ways of perceiving and interpreting self, other people, and events)
- affectivity (i.e. the range, intensity, lability, and appropriateness of emotional response)
- interpersonal functioning
- impulse control.
The pattern must be inflexible and pervasive, lead to clinically significant distress or impairment, be of long duration, with onset that can be traced back at least to adolescence or early adulthood.
Meanwhile, the possibility that these symptoms are part of another mental disorder, or caused by substance abuse must be ruled out.

In terms of BPD specifically, these elements will be characterised by a pervasive pattern of instability of interpersonal relationships, self-image and affects, and marked impulsivity.

It’s important to remember that diagnosis of BPD can be a double-edged sword. On the one hand, it can help people to identify their worrying behaviour, and work to improve their lives. On the other hand, it can expose the person to discrimination. A 2010 Australian Senate Committee on Mental health stated that “an end to marginalisation of the disorder within the community and the mental health sector, is urgently needed.”

Management
Many people with BPD will have the following treatment goals:
To regulate their emotional world
To find a sense of purpose in life
Development and maintenance of strong relationships

The best treatment results have been shown with Dialectical Behavioural Therapy. Dialectical means ‘concerned with opposing forces’, which here are “acceptance” and “change”. It involves working with a therapist to both accept the person as they are, and to appreciate the importance of change in recovery.

Given that a person with BPD experiences significant issues regarding real or perceived abandonment, and may also experience intense and uncontrollable mood swings - the challenge is considerable for treating health professionals, particularly if they are untrained in BPD. It is the responsibility of the health professional, however, to stay calm in difficult situations, as the maintenance of a strong therapeutic relationship is integral to positive treatment of BPD.

[Dagyo]

The worst part is the lack of identity. You get such intense feelings of anger and nihilism you feel like a downright sociopath. Moments later you’re filled with such joy you feel like a Disney character. It’s scary not knowing who you are

[Carlos-fekv]

Having bpd sucks... You snap or get into a mood swing when someone is arround and then when you're out of that episode you feel guilty and extremely sorry. That cycle can happen many times and in the end you just feel terrible and ask yourself. "Am i just and evil person?"
"Why am I like this?"
And many more terrible things

[rhiannonv]

The worst part is never being sure if you’re real. You feel like you’re watching your life through a TV screen.

[stormrider]

For me the worst part is that whenever I like someone I start obsessing over them to the point where I hate myself for it. My whole mood depends on their availability and how they treat me, I keep thinking of things I can do for them (as in giving them gifts or helping them out) because I'm so scared of them abandoning me and a small change in their behaviour can cause me bad anxiety and I react really emotionally. Its extremely mentally draining and I literally dread falling for someone again because my BPD always ruins it

[Aweshucks]

when you text someone and they don’t reply for 10 minutes, you just start to get worried then start hating them. That makes me feel bad

[amylovelock]

I always thought this was how everyone feels... Then I got diagnosed with BPD and I feel so alone and strange.

[lmeb]

The fear of abandonment is really, for me, the most crippling.

[mariaaa]

It was so weird having so much emotion but at the same time also feeling incredibly empty and numb. It was shocking to love a person then suddenly hating everything about them.

[dscrilla]

The worst part about having this is the feeling of emptiness, you can be around the most loving and cheerful people and still feel some kind of distrust, sometimes I push away people that really care and blame my self for it in the end, some days I feel normal then all of a sudden agitated with daily routines being negative then numb to the world and back to feeling upbeat and positive, its definitely a fucking rollercoaster..I had to take xanax just to feel normal

[aminacodes]

and people sometimes even romanticize BPD... it's really not cool to be clingy, impulsive, emotionally wrecked, empty and walk from idealization to degradation all the time, its not fun at all...

[Andrea-cekp]

for me the worst part is the loneliness, no one understands and no one even wants to. I truly feel like I am always alone and going insane

[ellanorris]

living with bpd is harder than most people understand. it is like having a constant nagging voice in your head, even if everything in your life is going well, telling you that people you can trust secretly despise you. it involves constantly second guessing every single behavior you exhibit, then changing your identity twenty times over to make sure that people don’t dislike you. you watch how other people interact and wonder how they’re not constantly on edge. you fine tune your personality to each and every individual you interact with to please them, then are accused of being dishonest because you do so. it is having such a fear of getting offended by others because you know that if you allow yourself to feel offended, you will hate them and you will feel guilty for hating them.

[arianachan]

I am crying rn idk y. Reading those comments makes me feel that there are still other people that can understand me

[joshr]

Currently fighting tears while reading these comments. I felt so alone in all of this and now I’m seeing comment after comment describing exactly what I’ve been struggling to explain.

[pelinozge]

i love never knowing if I'm idealizing ppl or if I actually like them

[Tierneycristian]

I was severely traumatized years ago as a teenage, got diagnosed with BPD. Spent my whole life fighting BPD. I suffered severe depression and mental disorder. Not until my wife recommended me to psilocybin mushrooms treatment. Psilocybin treatment saved my life honestly. 8 years totally clean. Never thought I would be saying this about mushrooms.

[thealya]

The worst part of BPD is the extreme idolising and intense hatred. Once my favourite teacher and a close family friend corrected me in front of the whole class and a boy laughed at me, I felt very embarrassed(I also have social anxiety). Ever since then I feel intense hatred towards her and I know I shouldn’t and it wast her fault but I can’t control the hatred. I have the same feelings towards my best friends, I either love them as they deserve or hate them for no reason.

[lizalbertson]

I’ve met a couple people w/ this disorder. All of them have a hard time keeping friendships with people.

[comotuabogada]

You, BPD patient who are reading this, I managed to reverse most symptoms. It is possible. It requires acknowledging stressors and studying the pattern of emotional reactions to such. Then you start working around that to reduce that reactive emotional response, identifying when it is excessive and when it's not. You get analytical and keep a cold head. And you keep working on it every day, at your pace, giving yourself time to express yourself and relax mentally whenever you need it.
It's all about 'equalizing'.
So hang in there 'cause as I did and still do, you can also get better and there is hope! So do something nice for yourself 'cause you got this! :)

[chansey]

I’ve had BPD for many years and I will never forget the time my boyfriend told me “you have more mood swings in 30 minutes than I do in a whole week”