Understanding Borderline Personality Disorder

By Laura Greenstein | Jun. 05, 2017

 

Selfish. Manipulative. Untreatable. Clingy.

This is how people (even mental health professionals) describe those who live with Borderline Personality Disorder (BPD). But considering what a person experiencing BPD deals with daily, these labels aren’t fair.

“People with BPD are like people with third degree burns over 90% of their bodies. Lacking emotional skin, they feel agony at the slightest touch or movement.” That’s how BPD specialist Marsha Linehan describes the deeply misunderstood mental health condition.

That badly burned “emotional skin” means people living with BPD lack the ability to regulate their emotions, behaviors and thoughts. In fact, “Dysregulation Disorder” would be a more exact, less stigmatizing name for the condition according to NAMI’s Medical Director, Ken Duckworth.

What Does BPD Look Like?

Like other personality disorders, BPD is a long-term pattern of behavior that begins during adolescence or early adulthood. But what makes BPD unique from other personality disorders is that emotional, interpersonal, self, behavioral and cognitive dysregulation. What does that mean?

Well, put simply: Relationships can deeply affect a person with BPD’s self-image, behavior and ability to function. The possibility of facing separation or rejection can lead to self-destructive behaviors, self-harm or suicidal thinking. If they feel a lack of meaningful relationships and support, it damages their self-image. Sometimes, they may feel as though they do not exist at all.

When entering a new relationship, a person experiencing BPD may demand to spend a lot of time with their partner. They will share their most intimate details early on to quickly create a meaningful relationship. In the beginning, they will show immense love and admiration to their partner. But if they feel as though their lover doesn’t care enough, give enough or appreciate them enough in return, they will quickly switch to feelings of anger and hatred. In this space of devaluing their partner, a person living with BPD may show extreme or inappropriate anger, followed by intense feelings of shame and guilt. These feelings often contribute to a self-image of being bad or evil.

Possibly because of this, individuals who live with borderline personality disorder are among the highest risk population for suicide (along with anorexia nervosa, depression and bipolar disorder). Completed suicide occurs in 10% of people with BPD and 75% of individuals with BPD have cut, burned, hit or injured themselves. These self-destructive behaviors are usually in response to threats of separation or rejection, but may also occur to reaffirm the ability to feel.

Diagnosing BPD

The estimated prevalence of BPD diagnosis is 1.6%, but may be as high as 5.9%. The number is unclear because BPD is often misdiagnosed and underdiagnosed. In fact, one research study showed that 40% of participants with BPD were previously misdiagnosed. We need to do better.

There are nine criteria listed in the Diagnostic Statistic Manual (DSM-5) to determine whether someone has this condition. A person must present with five or more of the following:    

  1. Desperate efforts to avoid real or imagined abandonment.
  2. A pattern of unstable relationships switching between extremes of admiration and hatred.
  3. Unstable self-image.
  4. Impulsivity in at least two areas that are potentially self-damaging (such as spending, sex, substance abuse, reckless driving or binge-eating).
  5. Repeated suicidal behavior and threats or self-harm.
  6. Erratic mood swings.
  7. Chronic feelings of emptiness.
  8. Intense anger or difficulty controlling anger.
  9. Temporary, stress-related paranoid ideation or dissociative symptoms.

BPD typically needs more observation than other mental health conditions to diagnose because the symptoms are often comorbid (paired) with illnesses such as depression, anxiety, eating disorders, post-traumatic stress disorder, substance abuse disorders and bipolar disorder. The book Borderline Personality Disorder: The NICE Guideline on Treatment and Management explains that the rate of comorbidity is so high that it’s rare to see an individual with solely borderline personality disorder.

While research hasn’t yet uncovered the exact cause of the condition, BPD is about five times more common among first-degree biological relatives of those with the disorder. Research also suggests that one of the major causes of the condition is trauma. In a study trying to treat 214 women with BPD, 75% of the participants had a documented history of childhood sexual abuse.

What Should I Do Now?

If you or someone you know was recently diagnosed with borderline personality disorder, here are a few first steps to take in managing this difficult condition:

Seek Treatment. Individuals who engage in treatment often show improvement within the first year. People with BPD are often treated with a combination of psychotherapy, peer and family support and medications.

Connect with Others. It can be incredibly helpful to have an emotional support system of people who know what you’re going through. It’s a reminder that you are not alone and you can recover. You can find others living with BPD through peer-support groups or online message boards or groups. For example, Healing From BPD includes a peer-hosted chat room.

Practice Self-Care. Part of healing is ensuring that no lifestyle choices are worsening symptoms and preventing recovery. Practicing healthy habits such as exercise, eating well and finding healthy ways to cope with stress and symptoms can be a key part of recovery. Also, it’s essential to avoid drugs and alcohol because these substances can worsen symptoms and disturb your emotional balance.

BPD should not come with a label of “manipulative” or “clingy.” It’s not a personality defect. It’s a serious personality condition that needs attention and care. If you experience this condition, keep in mind that these symptoms are not your fault. You are not behaving or thinking in a certain way because you are a bad or evil person: You are just a person who has a mental illness and you need support and treatment.

 

Laura Greenstein is communications coordinatior at NAMI.

 

Read our blog on the "gold standard" of BPD treatment, Dialectical Behavior Therapy,
by clicking here.

Comments
Bryan F
Kris. I recommend reading Lachkar's The Narcissistic/Borlerline Couple. The differences are pretty marked.
7/29/2017 9:05:06 AM

Janice
I have a 17 year old grandson who has been going to therapy since his parents got a divorce when he was 7 years old. We have been to so many therapist and Psychiatrist and none of them can tell us exactly what is the diagnosis of our grandson. ADD, ADHD, Bipolar disorder, Major Depressive disorder, Conduct Disorder, Borderline Personality Disorder and Tourette"s. He was in a hospital for weeks but that was worse for him he learned how to throw chairs etc. Still no real diagnosis. I was on line and discovered a book called Meaning from Madness by Richard Skerritt so went to his website and found this book and signed up for his news letter. This book was very informative and gave me insight to what may be going on in my grandson's head. After reading this book I found out that nobody can really diagnosis my grandson because the Personality Disorder is much like the Borderline Personality Disorder or Narcissistic Personality Disorder or Sociopath. Their incessant attempts to alter our perceptions of reality make it even more difficult to assess and deal with.
7/10/2017 9:18:26 PM

Yoli Broglio
Janice Tatosian: My 30-year old daughter also has BPD along with depression, anxiety, and (her doctor says) bi-polar. She sees everything as black or white, no gray, never any compromise. She is always right and everyone else is always wrong. She can be fine all morning then burst into a rage because she (inaccurately) perceived that someone was judging her. Her rages have been violent before - kicking, punching, tearing clothes, pulling hair. We have learned how to avoid them. Our beautiful girl has been like this since she was 12. She is very intelligent and gifted in languages and has been accepted to a number of prestigious colleges but has never been able to attend. A year and a half ago she gave birth to a little girl. Motherhood for the first year resulted in great calmness for our daughter. Now that the baby is toddling and into everything, our daughter's stressors have skyrocketed. Predictably, we are back to avoiding triggers to help keep her on an even plane. My husband and I long ago accepted that we will never retire to Florida or go on a round the world trip (unless they go with us). We accepted our daughter, imperfect as she is, and our grandbaby, who couldn't be more perfect. We take each day as it comes and do our best to live in the moment. Most times, I can honestly say that life is good. I highly recommend that you (and your daughter, when she is ready) take the Dialectical Behavior Training course. It is designed by Marsha Linehan, the chief 'guru' of treatment that works for BPD. The skills you will learn will help you get through your day and enjoy your life more. Find a DBT-certified therapist for yourself and your daughter. She should be seeing someone who understands and embraces BPD. Not all therapists do. Getting your daughter to go may take a very long time. Mine finally agreed once I started coming home and excitingly shared what I learned. (My husband and I also took a live conference call course designed for caregivers of family members with BPD that is offered through NEA. NAMI also offers a live course, "Family to Famly" that is probably offered near where you live. Both are highly recommended.) I feel your pain and frustration and encourage you not to give up. There is good help out there. The three of you can and will survive this awful brain disease. We are living proof of it. :-)
7/10/2017 11:15:35 AM

Kris Connor
What is the difference between BPD and Narcissistic BPD other than the obvious.
7/8/2017 7:14:25 AM

Sara Maginn
I am a mother of a almost 24 year old daughter.She has been tossed back and forth , side to side and up and down with various diagnosis's. It is definitely a mood, personality and focus disorder but no one will officially pin it down because my daughter wont let them. She has no filter in her brain. Processing information from brain to mouth is all one action. You never know what will come out of her mouth frpm one minute to the next. I am near the edge myself and no positive supports for her but for ME too. Lack of knowledge as I see it. Please send me a the "good word" for the day. I need one today, PLEASE.
7/7/2017 10:48:02 PM

Bre
My 16 year old daughter has BPD. We struggled for years before finally getting the right combination of medications, equestrian riding therapy, and DBT. No self harm in 6 months, no hospital, and 90's in school. There is a light in the tunnel.
7/7/2017 6:43:43 PM

Maureen O'Dougherty
I received great insight and support from a 12 week NAMI class I took on BPD (a Family Connections course) in Minnesota with a bunch of other people, who like me, have a family member/loved one living with BPD (diagnosed or not). NAMI MN also runs a peer support group, which then means ongoing, monthly support. Both really wonderful resources. The National Education Alliance for BPD gives great information.
7/5/2017 7:08:22 PM

Carol
I have a 34 year old daughter who was diagnosed with BPD 2 years ago. However, she has lived with this awful illness since she was about 14 years old.she was a high achiever and graduated as a nurse. However, she is now no longer able to work because of the anxiety, ptsd, alcohol abuse and eating disorder she suffers from. I don't know how to help her. I am at a loss as to what to do or say to her. She sometimes refuses to see her therapist because she's so tired. It seems to be getting worse and my fear is she tries another attempt on her life..
7/5/2017 5:34:17 AM

Cathleen
As an individual diagnosed with BPD many years ago and in recovery ever since, I am thrilled and so appreciative of seeing this blog! NAMI is such a leader in the mental health community and reaches a lot of people. Kudos to NAMI!

Also, what was especially helpful for me was my husband taking the 12-week course called "Family Connections" for those with a friend or relative with BPD (even though I was angry about it at the time). He learned DBT skills that turned our lives around and sent me hunting for my own DBT treatment. Because it worked! The non-profit organization that offers the free courses nationwide, of which I am now a member of its Board of Directors, partners with NAMI on many BPD projects. For course information, see: www.borderlinepersonalitydisorder.com and click on the "For Families" page!
7/3/2017 3:04:17 PM

Laura Propst
My daughter was diagnosed over a year ago for BPD. We took classes at NAMI and it really helped. But she still is in denial about her diagnosis. She was also diagnosed with Bipolar. At age 20, she began to use drugs and is in recovery for Heroin. I started an organization in 2013 in Pittsburgh, Not One More. We help in any way we can to find support and solutions for those suffering from addiction and the families as well. I believe that many people affected by addiction have undiagnosed or diagnosed mental illness and they try to treat themselves. Also, last year, we started to do research on a medication that I received for early labor while pregnant with my daughter. The drug, Ritodrine/Yutopar, was removed from US market in 1993 because of the effects on the mother's nervous system. We started a FB page about this issue as well. It's amazing how many women who took this medicine during their pregnancy have issues with their children. It is still used in China and the Netherlands. We share this info on our page, Not One More Pittsburgh Chapter, hoping to get the word out about these possibilities. There is a lot to learn and very little time when dealing with these mental illnesses and Heroin/drugs. Thankfully, we have several chapters now across the United States to help in some way.
My daughter still is in denial and seems to understand what happens when she goes off her medicine but doesn't get that drinking a few beers or smoking some pot affects her. I worry every day for my daughter.
7/3/2017 11:26:47 AM

Christa Dondero
I eas musdiagnosis first bipolar the later on with BPD. O was send to psychiatritic ward a lot due to self harming. In 1998 I took DBT (Dialectical Behavioral therapy). I learned skills that I can yse instead of hatming myself. I'm so grateful I took this class and been helpful. I hsven't cut since 2003. I practice the skill but I do need brush up. I had a very good therapist too. There is a book from Marsha Linehan. A workbook for DBT. It's helpful.
7/2/2017 2:58:08 PM

John
My wife has suffered from MDD, GAD, and either Bipoar (and/or) BPD for over 20 years. We have been married for 35. I hear so many caregivers pleading for assistance and training on how to cope, help and heal. One thing is clear to me. A care giver can not be a personal therapist. I can tell my wife something a thousand times and it will go in one ear and out the other. She will hear a therapist of councilor right away. (she may not comply, but she will hear it) Nami support groups have been the best help, but there should be classes and assistance for caregivers. I now suffer from GAD, and require treatment myself.
7/1/2017 9:24:47 AM

Ferguson Janice
I have a grandson who is a 17 year old teenager who has this disorder and my husband and I don't know what to do next. He has been in hospitals and gong to a therapist since he was 7 but to no avail.
6/30/2017 5:27:14 PM

Rosemarie R
I found myself in an emotionally abusive relationship and lacked the coping skills that I needed to see my way out of it. I was diagnosed with BPD and my mother had BPD. I found help through a DBT program (there is one in Tempe, AZ). Google DBT and Marsha Linehan and visit this website:
http://www.linehaninstitute.org. This is a mental health illness that CAN be overcome with knowledge and the right coping skills. I am also diagnosed with Bipolar Disorder and struggle more with that than BPD. Good luck everyone. Stay strong!
6/29/2017 11:45:15 PM

Ferguson Janice
This is a great site. My husband and I are trying to help our grandson who is a teenager. He is so disrespectful and uses bad language. We are fed up because we are all he has but he does not get it.
6/29/2017 10:53:51 PM

Cecilia de Sahagun
I have a 30 years old daughter she is bipolar and boderline , for 20 years we been living with her up and dawns, until she got pregnant nine years ago,
Since my grandson born I been taking care of him like my own child , with his short life he's has been seen the violence of my daughter against us ,her parents .
After so many years of her irrespecful behavior, today we put a invict order.
My hard is broken because she took my grandson away from us and she promised us that never going to see him again.
I just want to know if we did the correct.
But we can't live with this any more, so now we have to live with this empty .
6/29/2017 10:06:29 PM

Jem
It would be very helpful if some of the drugs used to treat BPD were listed. Obviously, a psychiatrist has to pick the best one for a particular individual but it still would put us in the ballpark. Also, my son does not want to take any med that can cause weight gain ( he is 24 ) or that makes him a "zombie" and changes his personality.
6/29/2017 5:26:54 PM

Janice Tatosian
I am the mother of a daughter who is 30, she has 9 out 9 of the signs. She has been labeled bi-polar, then a recent Dr. told her she had BPD from childhood trauma. She is now pregnant with a baby girl and she is worse now then ever... I just don't know how to help her; and I fear for her babies life as well as hers... I love her so much but this has been such a battle to try and help her. She knows she is ill but won't stay on meds or see a therapist on a daily basis. Now I have another human life to worry about.. I am on the verge of a nervous breakdown as I just don't know what to do.. I can't walk away from her because I know she is ill but of course she pushes me away.. I would love so much to talk to a professional in this field to help me on how to help her. She is my only child and fear of losing her and now her baby; this is paralyzing my life... Everyone is telling me to walk away from her because of her addiction but no ones understands the disease... Is there anyone in the Phoenix, AZ area that I can talk to... Thank you for this article...
6/29/2017 10:41:25 AM

Tara B.
My 15 yr old daughter has depression and anxiety and has been hospitalized 3 times for suicide attempts and suicide ideation. Can this disorder be diagnosed in children as well? She suffered a trauma at the age of 6 and has been in counseling and now under psychiatric care with medication but reading this article makes me feel like she has most of the qualification for this disorder. I pray that our society can learn to support mental health disabilities as it stands now the societal treatment brings more trauma to the table.
6/29/2017 8:46:09 AM

Heath
Is there no information for the partner who is trying to support the one with BPD? This disorder is not hard to understand but we (people in my shoes) need to know how to best handle things so our lives can get to a somewhat normal and more stable state. I love my wife. I hate to see her go through this. I need a real in-depth lesson so I can at least say I did what I was supposed to do. Help!
6/29/2017 6:53:22 AM

Heath
https://www.nami.org/Blogs/NAMI-Blog/June-2017/Understanding-Borderline-Personality-Disorder?utm_source=naminow&utm_medium=email&utm_campaign=naminow
6/29/2017 6:52:47 AM

Sandy
My 28 yo daughter has been seeing a therapist that thinks she has BPD. She is alcoholic, a heroin addict, bulemic, and has been in 7 treatment centers. I am completely at a loss as to how she will be on any given day. She has cut for years and attempted suicide twice. This is frightening to face but knowledge is power.
6/28/2017 9:45:33 PM

Yoli Broglio
Great blog.
6/28/2017 8:24:00 PM

Avery
Do some people with BPD outgrow this disorder? I was diagnosed in my early 30s. Now I am 48 and for the last 5 years my symptoms have all resolved. I am not on any medications. Is the resiliency or are their longitudinal studies that show how BPD progresses?
6/28/2017 6:00:45 PM

Beth
Is BPD the same thing as schizoaffective disorder? My daughter initially received this BPD diagnosis, then bipolar, then schizoaffective over the course of 10 years. She seems to have all the symptoms mentioned but also a great deal of paranoia and often, auditory or olfactory hallucinations. I'm wondering if her diagnosis really should be schizophrenia but she does seem to have rapidly cycling mood swings. These various illnesses have so many similar attributes, it is sometimes hard to tell the difference, but it makes a difference in the meds they prescribe. Can anyone tell me if BPD and schizoaffective are the same with just different names, depending on the physician?
6/28/2017 5:47:38 PM

Mary
I am 59 and have lived with but am not my mental illness. I have mental illness and do not introduce as , "Hello. My I'm borderline personality disorder and my name is Mary". In my personal and professional studies, years of counseling and surviving multiple suicide attempts I've learned to coexist with my illnesses. I'm also a survivor of suicide as both my brother and cousin completed suicide after many years of struggles. My life, although difficult for myself and others, has shown, thus far, to be one of joy and heartache, and depression, self doubt, and confusion. These are all feelings everyone deals with in their lifetime. However, there are those of us whom I believe have been born more tender of heart than most. Due to our most tender hearts, we have been ripped raw while wanting direly to be loved and accepted for who we are vs what people see us to be (unavailable, avoidable, self persecuting, and unlovable). You can be sure I know from my personal struggles as well as watching my brother's struggles that life with bpd can be exceptionally fulfilling. We are, after all, as human, if not more so, than are all others.
6/28/2017 4:54:25 PM

Kayden
Am actually one with D.i.D. (C-PTSD, some form of Psychosis, professionally diagnosed while having been with psychiatrist(s) & Psychotherapists over a span of nine years), but BPD and us are similar on behaviors and characteristics/traits, we are practically siblings. I really appreciate how this article was constructed. My sister and brother have BPD and my sister had just recently surfaced with it last year, and it was really terrifying for her to understand at first, and it still is I am sure, but this article really makes it easy to follow with definitions and steps. You helped knock away the stigma and defend us with reasoning and corrections. You all also did a really great job with reassuring everyone, especially those with BPD, at the end of the article, too. People who suffer with the negative effects of BPD deserve the absolute best in this world, I am wishing everyone happiness. Thank you again, NAMI.
6/26/2017 5:19:22 AM

Teresa Bunting
I just got diagnosed with BPD on June 4 the day after I attempted suicide. The description fits like a glove & I'm sooo scared!! Because I have been incorrectly diagnosed, incorrectly medicated & uneducated about it it ended up ruining my 12 year relationship with my soulmate.. He enjoyed us spending umpteen hours together he was the exact opposite of what I ever had!! But then my past started flashing back from a childhood of sexual & physical abuse, then also flash backs of my previous relationship which was him telling me to go hang out with the guy I call my "soulmate" he didn't want me around him well cause he was cheating on me then would come home fight & hit me around.. I never said a word though.. All of this built up so much I became so "evil" to my soulmate & my daughter from a previous relationship that within 4 years I destroyed 18 years of friendship & 12 years as a couple.. I wish people would understand how hard this is cause Lord I'd love to go home to him with the little girl he truly raised not her bio dad.. Just to be happy again..
6/22/2017 7:29:18 AM

CJ
I learned that my girlfriend had been diagnosed with this disorder. She exhibited 9 out of the 9 signs but remains in complete denial that anything is wrong with her. When confronted she says I'm the one who needs help. I had to finally give up and save myself. I hope someday she will be able to admit she has this disorder and seek treatment. I can't imagine living forever with this kind of anxiety, fear and misery.
6/11/2017 12:32:47 AM

Tania
Very interesting
6/10/2017 12:05:24 PM

Gabbie
This disorder feels like a terminal disease. It's killing me
6/9/2017 2:18:56 AM

Karen Brown
My daughter has bpd and i so much want to help her but its hard. I would love to know if there are any meet groups in the Bristol area so we can go along to together.
6/8/2017 11:49:40 AM

Shantelle Moore
My son in law was recently diagnosed with this, and this article really opened my eyes to his struggle. I wil encourage my daughter to stay in therapy as she was diagnosed with PSD disorder due my son in-laws past incidents...
6/7/2017 9:08:49 PM

Chriss T
After 45 years of struggling with thinking i was severley depressed my new therapist diagnosed me with BPD and Bi Polar. I have been on meds for almost a week a feel so much better!!!!! Thank you for your article. This is so me and it feels great to finally know whats really wrong with me!
6/7/2017 8:19:54 PM

Sarah
Great read. Fresh perspective on something painful in my life. Recs for how to help someone you think may have BPD & depression but doesn't have the insight to realize it and seek treatment?
6/7/2017 5:56:18 PM

Echo3R3vivify
Yes I agree with most but I am not at all manipulative or decieptful and hate lying except I guess I have been to myself
For years saying I am 'string' and 'donmt need protecting'. I do feel in many ways like although I have struggled trapping their emotions like everyone else, I know how to be free, free but fragile and vulnerable and in a world
Likethis we just don't feel we belong here.
6/6/2017 6:55:53 PM

MARY ANDERSON
I am interested in knowing what all of you think of the book "Stop Walking on Eggshells" for
those living with someone with borderline personality disorder. It helped me understand
my daughter in law.
6/6/2017 4:18:47 PM

Deborah Lam
My 15 yr old granddaughter (whom I care for) has been dealing with DMDD AND Borderline Personality Disorder since she was 10 years old. She started cutting in the 8th grade and that continues to worsen. She is a mass of scars. I need someone I can talk to as I feel very very isolated in this struggle. Her mother is disabled and I care for her also. She suffers from chronic severe depression along with a host of medical issues. Thank you for that post about bpd..the way my granddaughter talks to me is sooo awful and I am a very sensitive person and it is nice to know that she is not evil!!
6/6/2017 1:42:14 PM

Kelly McCabe
Help for those who care for such individuals needs to be addressed.
6/6/2017 10:45:58 AM

Pamela
This is probably the best article ive read yet. But a few things....
Not all people with bpd get angry and rage towards their partners when feelinf neglected Some just get very distant quiet and sullen.
Also with time education and therapy people can learn to, at most times, manage the darker symptoms.

Something that is never mentioned is how deeply people with bpd lobpd ce amd care for those in thier life. And those in healthy relationships are often (i cant remember the stats) more able to succeed in dealing with the darker aspects of bpd.
6/6/2017 10:21:07 AM

Martha K.Fay LCSW
Great article on BPD ! A keeper for sure!!!
6/5/2017 8:47:25 PM

JC
Great article. ...now how does a caretaker survive bpd? How can i best guide or live with a person with this and depression?
6/5/2017 7:57:31 PM

Kathy Prados
My 28 year old daughter has been diagnosed as bipolar, depression and anxiety. In reading this article, I believe she fits this category of mental illness. She is a drug addict and tends to get into relationships that are unhealthy. She has been to rehab and detox several times. I want to help her, but taking care of her for many years has taken its toll on my health. I'm completely lost.
6/5/2017 7:06:00 PM

arlene fazio
are there therapists in my zip code who treat this illness? 06468
6/5/2017 11:46:08 AM

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