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Borderline Personality Disorder & its effects on those who have it
Sam Lauria
INTRODUCTION
Borderline personality disorder (BPD) is considered to be one of the most difficult mental illnesses to live with, yet very little is known about it.
Living with BPD is incredibly hard because of the toll its symptoms have on people who have the disorder. These symptoms range from: extreme mood swings, paranoia, unstable interpersonal relationships, intense fear of abandonment, explosive anger, impulsivity, self-destructive behavior, and identity disturbances. People with BPD have little to no control over their thoughts, emotions, and behaviors.
This constant emotional instability extends to every aspect of a person’s life, resulting in many difficulties regarding relationships, employment, and well-being. People with borderline personality disorder have a negative reputation in society and are often vilified for their uncontrollable symptoms by people AND professionals. There is currently no known cure for BPD.
Section Guide
Diagnostic Information
According to the DSM-5, BPD is a mental illness characterized by “A pervasive pattern of instability of interpersonal relationships, self- image, and affects, and marked impulsivity.”
In order for someone to be diagnosed with BPD, they must have five (or more) of the following symptoms:
fear of abandonment
Frantic efforts to avoid real or imagined abandonment.
impulsive behaviors
Impulsivity in at least two areas that are potentially self- damaging (e.g., spending, sex, substance abuse, reckless driving, binge eating).
feelings of emptiness
Chronic feelings of emptiness.
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unstable relationships
A pattern of unstable and intense interpersonal relationships characterized by alternating between extremes of idealization and devaluation.
suicidal tendencies
Recurrent suicidal behavior, gestures, or threats, or self- mutilating behavior.
inappropriate anger
Inappropriate, intense anger or difficulty controlling anger (e.g., frequent displays of temper, constant anger, recurrent physical fights).
identity disturbance
Identity disturbance: markedly and persistently unstable self image or sense of self.
mood instability
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).
paranoid ideation
Transient, stress-related paranoid ideation or severe dissociative symptoms.
how bpd is formed
There are a variety of factors that contribute to the formation of BPD. Most cases are manifested through stressful or traumatic experiences, but others can be caused by genetics.
Joy Bolger, a psychology professor and mental health clinician at Stony Brook University, says that “The pathway to BPD is elusive— we don’t know why it develops,” adding“most people that have BPD were not validated during childhood for having emotions or experiences. They don’t learn how to regulate their emotions according to a situation.” This makes them heavily reactive to the environment around them.
There are a few common environmental factors that lead to the development of BPD. They include physical, emotional, or sexual abuse; reoccurring distress or feelings of fear during childhood; parental neglect; or growing up with another person who struggles with mental illness or substance abuse.
Bolger says that BPD is a “disorder of perception” because patients who have been diagnosed with it perceive the world around them at a more emotionally intense rate than those without the disorder. As a result people with BPD tend to have heightened emotional responses to their perceived surroundings.
common triggers
People with BPD have trouble regulating their emotions, and maintaining relationships with others. This combined with their fear of abandonment often leads to what professionals call “episodes”. Ingber states that episodes are triggered because of an invalidating experience.
Perceived or real abandonment
Locations that invoke negative memories
Reminders of traumatic events
Rejection of any kind
Ending a relationship
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Loss of a job
why it's hard to
get diagnosed
Here are of the most common mental
disorders BPD gets mistaken as:
Bipolar
disorder
anxiety
depression
eating
disorders
Borderline personality disorder is hard to diagnose. Abby Ingber, the executive director of the National Education Alliance For BPD, says that BPD is an incredibly unique disorder in the fact that it presents so differently among patients. “One person could have BPD and have five traits. Another person could have BPD and have five traits but they would only have one trait that overlaps.”
Symptoms of BPD often resemble other psychiatric conditions such as bipolar disorder, depression, anxiety, and eating disorders. People with BPD often have comorbid diagnoses— meaning having one or more conditions at the same time. According to Bolger, BPD most commonly gets diagnosed with a mood disorder— such as bipolar.
Additionally, since BPD is a personality disorder, it is often quite hard for individuals to differentiate between their symptoms of BPD from their actual personality (how they view the world, how they interact with others, and how they perceive themselves). “A personality disorder isn’t something that happens during an episode. Your personality is your personality and you take it with you throughout your life.” She continues on stating that even though it’s hard to diagnose BPD, a trained clinician will know the differences.
episodes
People with BPD experience severe mood dis-regulation, in the form of extreme episodic outbursts. These fluctuations in mood are typically triggered by an invalidating experience. Episodes can happen almost instantly and can last anywhere from a few hours to a few days. Harrison Hards, a fire spinning performer who was diagnosed with BPD in 2021, said that he experiences a lot of happy highs and a low of depressing lows. He said “Every time something changes my mood, it changes my mood. Very quickly. It’s very quick, very often, all the time.” There are a few different types of episodes that people with BPD can experience.
Splitting is defined as a means for a person who has trouble assessing the
motivations of an individual or situation. Ingber says that splitting is a
psychological defense that results in a “black and white” mindset where individuals
view others or themselves as either “good” or “bad”. There is no middle ground.
People with BPD have trouble comprehending the complexity of human characteristics and often
have trouble understanding that there is a gray area that lies in between the good and the bad.
Jane Cumming, a college student that was diagnosed with BPD in 2022, was asked to
describe what splitting feels like, to which she responded “One minute I’m completely
fine and the next minute someone says the wrong thing or something I don’t
want to hear and I just go off the rails.”
Borderline rage is categorized as explosive, inappropriate episodes of anger that are difficult to control and can have devastating effects on a person’s relationships. People with BPD express their emotions differently than others. They're sensitive to things that may not seem that serious to someone without the disorder— hence the term “inappropriate.” Borderline rage commonly results in yelling,
making rude statements that they don’t really mean, and, in some cases, physical violence.
Mya Attwood, who was diagnosed with BPD in 2022 and is currently unemployed, stated that
their episodes of anger cause them to get worked up. It could sometimes have physical
results. Attwood said that they would damage a lot of things and then get upset because
they damaged it. "Last time I had an episode, I went into my room and I threw a
suitcase at the wall. Afterwards I felt bad because I could’ve put a hole in the
wall had I thrown it a little bit harder. The worst thing is you can’t really
control it.”
A depressive episode is a period of time in which a person with BPD
experiences extreme feelings of depression that result in mental pain
feelings of intense sadness, chronic boredom, emptiness, and loneliness. Although the two are similar, a borderline depressive episode is different compared to other depressive disorders.
Depressive episodes usually result from interpersonal losses— such as a breakup. Any positive
feelings someone with BPD had about themselves completely disappeared. They are only left with
feelings of self-hatred and pointlessness. When in this state, individuals with BPD may turn to
methods of self-harm in order to help them cope with their imagined loss.
Harrison Hards, a fire spinning performer who was diagnosed with BPD in 2021, described a depressive episode as feeling “more protected”. Even though he feels like he’s been abandoned and isolated, he said “ I feel like I got myself... until it gets to a crisis where I don’t got myself.”
On the other hand, a euphoric episode is a period of time in which
someone with BPD experiences a rush of positive emotions, impulsive
behaviors, and extreme highs. During a euphoric episode, someone with BPD
will find themselves being unable to sleep, sometimes staying awake for days at
a time. They will have extremely poor judgment. They engage in risky behaviors like
excessive spending, substance abuse, or reckless sex with no worries about the negative
consequences their actions may have.
Hards said that he experiences a lot of happy highs and a low of depressing lows. He said “Every
time something changes my mood, it changes my mood. Very quickly. It’s very quick, very often, all
the time.”
Although euphoric episodes are rooted in feelings of happiness, they are just as harmful as depressive episodes. Hards stated that “Being too happy is more dangerous than being depressed. Because when I’m too happy, I lose control of myself. I’m aware of everything that’s going on, but I can’t help it.” Hards then described a depressive episode as feeling “more protected”. Even though he feels like he’s been
abandoned and isolated, he said “ I feel like I got myself… until it gets to
a crisis where I don’t got myself.”
abandonment
Because they grew up in an invalidating environment, people with BPD tend to have an intense fear of abandonment. This fear, whether it be real or imagined, causes people with BPD to have difficulties maintaining healthy relationships.
People with BPD tend to base their worth on what others think of them. They need constant reassurance from those around them in order to feel secure in a relationship.
If these emotional needs aren’t being met, a person with BPD may resort to tactics that sabotage their relationships as a result. The actions that people with BPD take in order to prevent someone from abandoning are often the reason why people leave— amplifying the fear that they try so hard to prevent.
When they feel that they’re being abandoned, people with BPD will go to extreme lengths in order to avoid others from leaving. It’s typically displayed through actions of oversharing, misplaced anger, impulsivity, lashing out at loved ones, or devaluing their partner. In some cases, people with BPD resort to manipulative tactics to prevent people from leaving them. However, these efforts only continue to push the people that are close to them even further away.
“They feel that everyone is going to leave them and they get scared of that because they have chronic feelings of emptiness and this fear of abandonment.” says Bolger. “So when they feel that someone is going to leave them, they act out.” She said that these behaviors can be very stressful for other people because they never know when these emotional outbursts will happen— nor does the person with BPD.
“I’m able to do everything physically, but as far as receiving emotional stimulation, I feel like I would not be able to get to the level I want if I don’t have other people around me.” Cumming stated.
Attwood stated that they come off as if they’re gaslighting when trying to keep people from leaving— even though it's not intentional. “There’s a part of me that feels everyone will leave and I’ll be stuck alone and I’ll be unhappy for the rest of my life. But then at the same time, I push people away.”
“I felt like they were going to leave me,” said Hards. “Everything pointed to them leaving me. I was like “I’m going to kill myself if you don’t tell me if you like me or not. It wasn’t deliberate either. I was absolutely ready to do it but I just wanted to know whether they wanted to be with me or not.” After Hards got his clarity back, he realized his actions were wrong. He said “I actively avoided doing that again. It was not a good thing.”
“I feel dependent on them. I’m constantly trying to make them want to talk to me and want to be in my life."
- Jane Cumming
“It’s not that they’re the most important person, it's that they’re the only person. I’m not going to see that you’re being mean. I’m just going to see that you’re this amazing person when in reality, you’re a manipulative asshole.”
- Harrison Hards
"A favorite person is “a person that I put on a pedestal. I worship them like they're my god.”
- Mya Attwood
I felt like I dragged us more apart the more I tried to get [my fp] closer to me.”
- Jane Cumming
“My world is crashing because I’ve done something wrong. You’re the most important person to me. And now that you’re gone, my world is burning.”
- Harrison Hards
One unique facet of BPD is the concept of a “favorite person”. A favorite person (fp) for someone with BPD is “the most important person in their life”. Someone with BPD uses their fp as their sole source of happiness, validation, and stability.
This dynamic will cause someone with BPD to shape their mood, confidence, stability, and sense of self to match that of their fp. They form an extreme emotional dependence on them— relying on their approval, reassurance, and guidance to go about their own lives.
​
People with BPD become obsessed with gaining the attention of their favorite person and will often go to extreme lengths to obtain it. Since they have such a poor sense of self, people with BPD will mirror their favorite person, changing aspects of their own personality to match their fp’s. They want to spend every moment with their fp, forming an unhealthy emotional dependence on them.
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Having a favorite person is a double-edged sword for both parties involved. The relationship between a person with BPD and their fp will initially seem like a healthy relationship, but will quickly devolve into an intense, unpredictable cycle of idealization and devaluation.
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The person with BPD will initially believe that their fp is a perfect person. People with BPD idolize their fp, crave their constant attention, and will make their top priority their fp’s happiness. Sometimes, a favorite person will take advantage of the obsessive feelings.
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Favorite person relationships are not fun. They can be emotionally taxing, manipulative, and traumatic. The best way to combat this toxicity is communication between someone with BPD and their fp. According to Choosing Therapy, the best way for a favorite person to help someone with BPD is to “acknowledge when they become upset or don’t feel adequately heard but also keep strong boundaries.”
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favorite person
stigma
"We're depicted as
monsters who don’t
care and are abusive.”
- Mya Attwood
BPD is considered to be the most stigmatized mental disorder. Because so little is understood about this disorder and the negative tendencies that people exhibit when triggered, people with BPD have earned a low ranking in society. They are often labeled as “manipulative”, “attention seeking”, “abusive”, or “dangerous”.
​
When looking up borderline personality disorder, it won’t be long until you come across search results that state why you should stay away from people who have BPD. These searches range from: “Why are people with BPD so rude?”, “Are borderlines master manipulators?”, “Do borderlines have empathy?” “Are all borderlines abusive?”, “Can you trust someone with BPD?”, “Do borderlines ever apologize?”… just to name a few.
“You want to be my favorite person? Do you want me telling you at midnight that because you didn’t message me fast enough I’m going to kill myself. Do you want that? No? Didn’t think so.”
- Harrison Hards
in the media
BPD-related content in the media is shrouded with misinformation. On social media apps, the term "self-diagnosed" seems to becoming trendy among young people. People could "claim" to have any mental illness and spread false information about a disorder they potentially don't have. The self diagnosis trend is ruining our perception of the disorder by giving people an incorrect view of what BPD is and its symptoms.
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Additionally, many fictional villains in the media seem to be BPD-coded. The consistent negative portrayal of those with BPD heavily contributes to the stigma surrounding the disorder and people's perception of it.
See how many of them you could recognize!
“I’m not purposely trying to make people do things. I’m expressing how I feel. I don’t want people to think that I’m doing it on purpose.”
- Jane Cumming
Anakin Skywalker
- Star Wars
“People see it as “You’re a lost cause. There’s no helping you. You’re too messed up. Go away.”
- Mya Attwood
“They said "You’re just being a teenage girl.” I was like “How come none of my other friends have these issues?”
- Jane Cumming
“I think it’s because of emotion regulation problems, but also boundary breaching behaviors can be off putting to medical staff. They have this sense of “This is going to be a difficult patient and I don’t want to take that on.”
- Joy Bolger
in the medical field
There has been a significant increase in the number of mental health advocates that actively fight to reduce the stigma around mental illness. However, this activism does not always extend to BPD. “BPD is presented as a disorder where there is no help. There is no support. Just cut them out of your life.” says Ingber— who believes that this is a toxic mentality to have when treating BPD. Studies show that mental health professionals have more stigmatizing views about BPD than all other mental disorders.
There are a concerning number of professionals who refuse to treat patients with BPD. Certain professionals feel that people with BPD are difficult to deal with. “I think it’s because of emotion regulation problems, but also boundary breaching behaviors can be off putting to medical staff. They have this sense of “This is going to be a difficult patient and I don’t want to take that on.” says Bolger.
Borderline personality disorder is a lifelong disease regardless of treatment so people with the disorder are often labeled as “treatment resistant”. This harmful term can evoke a sense of defeat among professionals since BPD requires constant and rigorous treatment. This prejudice against BPD reinforces the stereotype that people with the disorder are “unfixable” and should not be treated.
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Bolger says that professionals that do treat BPD are usually not equipped with the proper training that its treatment requires. This results in sessions that feel inadequate or void of progress to professionals. This results in unsuccessful treatment sessions that can leave the patient feeling confused or judged. On the other hand, patients with BPD will feel confused or judged, putting them in a worse state than before they started receiving treatment. Additionally, their fear of abandonment may be amplified when getting refused treatment from the people who are supposed to help them.
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Ingber believes that BPD research is far behind that of other disorders— which increases the stigma. “You can have people who went to school for four to six years to get their PhD and they probably spent less than one day learning about BPD.” Ingber continued on by mentioning insurance policies surrounding bpd treatment. “If you have a brain tumor, your insurance company isn’t going to cover you to go to the podiatrist. The mental health world has not caught up to that. They’ll send you to the cheapest option possible.”
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“I’ve had people use it against me. My mum in an argument will literally say “You’ve got BPD. You see the world differently from the truth.”
- Harrison Hards
“BPD is presented as a disorder where there is no help. There is no support. Just cut them out of your life.”
- Abby Ingber
TREATMENT
There is currently no known cure for BPD, but that doesn’t mean someone can’t overcome the disorder. It was recently discovered that BPD symptoms can go into remission over time. A 2015 study states that most people can outgrow their BPD symptoms, resulting in remission. The percentage of people with BPD who go into remission is still unknown— ranging anywhere from 33% to 99%. Although they are not 100% effective, there are a variety of treatment options that can help alleviate symptoms of BPD.
THERAPY
cognitive behavioral therapy (CBT)
A problem-oriented strategy that is seen as the foundational approach to all forms of talk therapy. It is incorporated into all forms of psychotherapy.
dialectical behavioral therapy (DBT)
A subset of CBT that’s targeted to those suffering with emotional dysregulation. It aims to identify negative thinking patterns, control emotional outbursts, and teach distress tolerance.
Mentalization Based Therapy (MBT)
A long-term form of psychotherapy that teaches us to “think about thinking”. It makes sense of one’s thoughts and beliefs about themself and the world around them.
Schema Focused Therapy (SFT)
A short-term form of therapy that identifies and changes the thoughts and behavior patterns someone has about their past. It is an evidence-based form of therapy that looks for solutions to dealing with traumatic memories.
System Training For Emotional Predictability And Problem Solving (STEPPS)
A 20 week educational program that aims to help people with BPD identify behaviors and feelings that come with the disorder. It gives them the necessary skills that allow them to change negative behaviors and manage emotions.
MEDICATION
Reduces the intensity of depressive episodes by increases serotonin levels in the brain of those with BPD
Reduces the intensity euphoric episodes, and psychotic symptoms of BPD by blocking dopamine receptors in the brain
Reduces emotional instability, impulsivity, self-harming behaviors, and anger by targeting neurotransmitters that cause a mood disturbance
Reduces symptoms of anxiety and panic attacks by suppressing brain activities that cause or increase anxiety levels
conclusion
We still have a long way to go in regard to destigmatizing and fully understanding borderline personality disorder. “This is not something that someone chooses to have.” states Bolger. “Once we understand that they’re not purposely trying to act out or cause problems and learn that they have something that needs treatment, then maybe the stigma will be reduced.”
Cumming, Attwood, Hards, Bolger, and Ingber detailed the steps that people should take to understand BPD. There was a common theme in all of their responses: education and communication. Their responses are as followed:
Jane Cumming
Cumming stated that it can be hard to determine what information about BPD is reliable because of the overwhelming stigmatizing misinformation. “Talking to someone that actually has BPD can be very helpful because they have a better understanding of what it's like to actually experience it. They can bring in that raw experience.”
Harrison Hards
Hards believes that doing research is key to understanding BPD. “If you know someone who’s got BPD, ask them instead of just assuming. They might not open everything up, but I’m sure they’ll help you understand it better.”
Mya Attwood
Attwood said that we should ask questions. “Communication is key— especially when you have BPD.” Effectively communicating with someone who has BPD will help us recognize and understand the signs.
Joy Bolger
In the case of licensed professionals, Bolger outlines what they should do when treating someone with BPD. “The thing that a therapist has to do in that situation is to stay in it. Don’t walk away. Their view of relationships is that everybody leaves. So the therapist cannot ruin that by terminating the contract with a patient that has BPD.”
Abby Ingber