When I first thought about Borderline Personality Disorder or BPD. A few things came to mind: fear, that it was a “woman’s issue”, but mostly that it was a VERY difficult disorder to have or treat.
Since my often wrong “first thoughts”, I have learned a lot about BPD, and with exposure, reading, and opening my neural pathways I have grown to understand that although it has a bad wrap in society, it is a very interesting and important disorder to treat and understand.
Per usual, some Psych Myth Busters:
1. Only women get BPD.
While the vast majority of BPD cases are in fact female, 2 out of 10 cases are male. 20% is a large number to look over, and researchers have also stipulated that men tend to not seek help for mental health issues as often as women. Thus, as far as we know–gender doesn’t play a significant role in BPD.
2. All people with BPD are liars and/or manipulative.
While some with BPD may feel one thing one moment, and say another the next–the words are very much a part of their reality and not an intentional “lie”. While a pathological liar can also have BPD, it is not a trait or characteristic of the disorder.
3. There is no help for those with BPD.
Like most mental illnesses, there is no “cure-all”. However, with time, therapy, medication, and dialectical behavioral skills training, many with BPD can mitigate most of their symptoms and learn to healthfully interact in relationships. There’s also evidence that suggests some BPD people “outgrow” parts of their illness by the age of 40. While this is still under review, it may be important in understanding some of the cognitive processes impacting BPD.
4. Those with BPD enjoy hurting people and are attention-seekers.
SO WRONG. Although it is an unfortunate side-effect for some, most people with BPD are usually trying to cope with really difficult emotions and in doing so, can often hurt the ones they love most. Again, it is not intentional, and understanding that critical distinction provides a space of empathy that is much needed to heal this population.
Theories on causality:
1. Genetics: Nature likely takes a role as there is ~65% likelihood of inheriting BPD from a BPD parent.
2. Cognitive processes: Although these processes haven’t been explicitly identified, there is evidence showing abnormal brain activity for those with BPD in various regions including the amygdala and executive functioning (AKA handling emotions, perception, decision-making, and organizing information regions).
3. Environmental factors: One common theme among the research indicates that neglect, poor parenting, or trauma in childhood has been a key correlation to this disorder. While I rarely encourage putting psych disorder blame on parents, it is important to understand the role in making a child feel safe and loved in childhood to develop into healthy adults. Many theorize that those with BPD saw emotion regulation displayed in an unhealthy way, and in turn, perhaps developed those traits and saw love as equivalent to unhealthy emotional displays.
What we do know is that it is VERY likely a combination of all these factors. I like to say it takes a “cake” to create a disorder. The genetics are the eggs, the cognitive processes are the milk, and the environmental factors are the flour (so to speak).
Those with BPD have to meet 5 out of the 9 criteria listed below. This means that there are 200+ combinations/manifestations of BPD.
Some other signs and symptoms include:
Every case of BPD is unique. Below are 4 common divisions (according to Theodore Millon) that only begin to breach what various combinations may look like:
1. The Discouraged BPD: This type tends to look like how a lot of us were in middle school. Go with the crowd, clingy, a bit codependent on the thoughts of others, but inside very disappointed. They often feel anger, unrealistic rejection, and a lack of a sense of self. When this anger does surface it’s often turned inward and manifests in self harm and suicidal ideation.
2. The Petulant BPD: This type is torn between relying on others and pushing them away for fear of rejection (the “If I push you/hurt you first-I protect myself” mentality). This often manifests in complaining and irritability to full blown aggression and hostility. They often experience both feelings of unworthiness and anger towards others, making it very difficult to control their emotions.
3. The Impulsive BPD: This type sounds just like the name: they are thrill-seekers with charm that get themselves into a whole lot of trouble. The best metaphor I have is like a person who is drunk and a lot of fun, but has lost their inhibitions and thus, engages in wreckless activities. While this type is often the most fun to be around, their disorder can lead to very serious consequences.
4. The Self-destructive BPD: This type is particularly difficult to have. Whether conscious or not, BPD’s that are self-destructive manifests by self-harm ranging from cutting/physical self harm to social self harm (performing humiliating acts, quitting their jobs, poor hygiene, wreckless driving, etc.
While this is just a SMALL sample of the differences in BPD manifestations, the one take away is (like with most mental illness) every case is different!
I’ll try to wrap this post up at this point, but I look forward to delving in deeper in Part 2: “What it’s like to have BPD” and “How you can support a loved one with BPD”.
Until next time, J out.