Borderline Personality Disorder

Effecting 1.6% of the population or 4 million people in America, Borderline Personality Disorder, or BPD, is more common than schizophrenia and bipolar disorder combined. Most of these diagnoses are women however it is hypothesized that the stigma of mental illness contributes to men not seeking a diagnosis and treatment. It is being renamed to Emotional Dysregulation Disorder, Emotional Intensity Disorder or Emotionally Unstable Personality Disorder around the world to help spread more awareness and to better explain the disorder.

With nine symptoms, the disorder is complex and difficult to treat due to the severity of the symptoms. There are 256 possible combinations of symptoms making it unique for every person. 

Black and white thinking, or splitting, is when a person with BPD immensely loves something to extremes but one day, loathes the person or thing for no real reason. They flip back and forth between love and hate and many struggle to have moderate feelings as their love is all or nothing. They can split on a job and walk out, split on a hobby and throw it all away or split on a person and leave them.

The intense emotions and push/pull reaction of those with BPD stem from their deep fear of abandonment and rejection. Their ability to suddenly hate a person allows them to walk away before their subconscious perceived abandonment. Most of those with BPD are childhood  abuse victims and this coping mechanism often develops to deal with abandonment as they learned how to cope in their abusive unsupportive environment. 

Suicidal thoughts are present in most cases and 80% of those with BPD will attempt suicide in their life time at least once. Self harm is also a hallmark symptom as most borderlines self harm and most self harmers have borderline. This can be anything from cutting, burning, head banging or intentionally starving themselves. 

Impulsive behavior is also a problem and can be illustrated as road rage, reckless spending, sex, drug use or an eating disorder.

Their underdeveloped emotional regulation often leads to dramatic emotional episodes of extreme anger, extreme sadness, extreme happiness and so on. While an average person has an emotion scale of 0-10, with 10 being intense, a person with BPD has a scale of 0-20 as their emotions are extremely intense and usually unwarranted. One comment from a friend can result in a suicidal episode or an argument can result in broken dishes, slammed doors off hinges or self harming behavior. 

Paranoia is also common as those with BPD are often the victim of emotional abuse and manipulation. However, they also self perceive themselves as a victim when they may not be in that specific situation. They may believe a friend is plotting against them or their spouse is cheating. This can often lead to destructive behavior or splitting to cope.

A deep haunting feeling of being “empty” and purposeless is another symptom. Those with BPD often sift through various jobs and hobbies as they are always on a hunt for fitting in, happiness, stability and a purpose in life. The empty void is often filled with impulsive behavior and/or self harming behaviors.

While the mood swings of BPD mimic those of bipolar disorder, they are not the same as unlike bipolar disorder, BPD mood swings are usually based off of environmental factors, such as rejection or abandonment and the mood swings of bipolar disorder are a chemical imbalance. The mood swings of BPD can last hours or days. A long standing constant episode (multiple days or weeks) may indicate bipolar disorder rather than BPD.

Disassociation is also common and seen as a left over coping mechanism from their years of abuse. They learned how to emotionally remove themselves from the world in order to cope with their pain from trauma. Emotionally tuning out of life can destroy stability in everyday life and some may find themselves in lengthy episodes which cause them to feel only partially present. This act of stepping back is seen as a sort of “out of it” state that plagues many. Some report episodes last for hours or days while others report weeks or longer. 

The emotional immaturity of those with BPD makes every day life difficult. Many struggle to maintain basic relationships, jobs and a social life. Many do not work and their life history is usually speckled with job loss, school failure and general lacking the ability to interact with the world in the way their peers do.

The diagnosis of BPD can be difficult as it mimics bipolar disorder and post traumatic stress disorder. The diagnosis is often only given after reaching adulthood as some symptoms can be the result of teenage angst which are outgrown in maturity and not the result of having BPD.

While it has been seen as one of the most complex and difficult to treat mental illnesses, some new therapies are offering hope. However, the poor access to regionally close medical care, lack of insurance, the high cost and other factors present a road block for many. 

Some improve with age and treatment while others live with the disorder their whole life. Some are receptive to therapy while others reject it. Society sees those with BPD as manipulative, abusive, dramatic and attention seeking. There is an ongoing debate in the actual legitimacy of the disorder as some believe the behaviors of those with BPD are simply to garner attention or sympathy. 

BPD is a misunderstood disorder. The people with BPD are typically very sensitive and emotionally intense. They love fiercely and passionately with little holding them back. As they struggle in day to day life, many are secluded from society as a result of self isolation or explosive behavior that makes them an outcast.

With more awareness, those with BPD will gain more access to information, diagnosis and treatment. The jaw dropping suicide rate is nearly 500 times that of an average person, making it the deadliest mental illness. With more accurate information, the stigma of BPD will be fought and these passionate souls will gain more acceptance and support.