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Borderline Personality Disorder (BPD) Awareness Month (and Mental Health Awareness Month) comes around every May—and that’s a good thing, because awareness is something that’s truly needed about this often confusing, nearly always disruptive condition. It’s thought to affect 1.4% of U.S. adults, but the National Alliance on Mental Illness (NAMI) says that number may actually be as high as 5.9%. More women than men are diagnosed with BPD, though research shows that it may hit men just as often and simply be misdiagnosed as depression or PTSD.
According to the National Education Alliance for Borderline Personality Disorder (NEABPD), there’s a great deal of misunderstanding and stigma about BPD. “Borderline personality disorder is both misdiagnosed and under-diagnosed,” says Perry D. Hoffman, PhD, the president and cofounder of NEABPD. “And some clinicians won’t see patients with BDP, in part because of the stigma that it’s untreatable—which just isn’t true.”
Let's clear up some of that confusion—here are answers to six common questions about borderline personality disorder:
What is Borderline Personality Disorder?
Borderline personality disorder is a serious mental illness that brings about disruptions in mood, self-image, and behavior. People who experience it have trouble regulating their emotions; they feel things intensely (and for long periods of time), and it’s harder for them to come back to a stable place. Some people with BPD are high-functioning, but for many others, it can be hard to function in their daily life. People with BPD may have trouble hanging on to a job or completing their education, have a substance abuse disorder, get involved in abusive relationships, have run ins with the legal system, and/or do themselves harm.
People with BPD have trouble regulating their emotions; they feel things intensely and for long periods of time.
What Are the Symptoms of Borderline Personality Disorder?
Symptoms can include the following, but note this—the National Institute of Mental Health (NIMH) points out not everyone who suffers from BPD experiences all of these symptoms, and they can vary in intensity:
• Mood swings
• Inappropriate anger, plus trouble controlling it
• Black-and-white view of life: Things are either all good or all rotten.
• Strong fear of abandonment by family and friends, which can make it hard to tolerate being alone.
• Anxiety and/or depression that can last anywhere from a few hours to a few days.
• Pattern of unstable relationships, swinging from feelings of idealized love to intense dislike or anger.
• Shaky and distorted self-image or sense of self
• Impulsive and risky behaviors, which can include substance abuse, unsafe sex, reckless driving, and runaway spending
• Self-harming behaviors, like cutting, as well as recurring thoughts and/or threats of suicide
• Disassociation (feeling cut off from oneself or feelings of unreality) and feelings of emptiness
Do Experts Knows What Causes Borderline Personality Disorder?
Research on BPD is still in the early stages—there just hasn’t been sufficient focus on it, experts say. They agree, though, that it’s probably brought on by genetics (according to NAMI, it’s about five times more common among those who have a close relative with the disorder) and environmental influences: early childhood abuse, for example, and other traumatic life events. But experts also point to a difference in brain function in people with BPD—specifically, that the parts of the brain that control emotions and judgment might not communicate well with one another.
“People with severe and chronic emotional dysregulation are like Ferraris, with the accelerator pedal—the amygdala, which manages emotions and generates impulses—sort of stuck to the floor,” says Marie-Paule de Valdivia, an assistant clinical professor in the psychiatry department of the Yale School of Medicine, and an expert in BPD. “But picture that Ferrari with tiny little Fiat brakes.” (The brain's “brakes,” de Valdivia explains, are located in the prefrontal cortex, where reasoning, figuring out consequences, and goal setting take place.) “So when all goes well and the road is open and straight, these race cars can go so much faster than most all other cars—but as soon as a curve shows up, they careen off the road and smash spectacularly, and the rest of us are completely confused, in part because they’re so capable on the road at some other times. And also because the people who love them have warned them several times, very loudly, that the curve was coming, to no avail—again.”
Psychotherapy is generally the first line of treatment—ideally, a session or two a week with a counselor.
Can People with BPD Have Successful Relationships?
Many of the symptoms of BPD have an impact on relationships, which often makes work, friendships, or romance challenging. A person with BPD may feel intimate and close to someone one day, and then their perception of that person might change. The fears of abandonment might lead to the person remaining in an unhealthy relationship or even one that’s abusive. “With treatment though, the person can learn how to manage their emotions more effectively,” says Dr. Hoffman. “And optimally, the partner can also participate in a program that offers skill building on their end.”
What Treatments Are Recommended for Borderline Personality Disorder?
Psychotherapy is generally the first line of treatment—ideally, a session or two a week with a counselor that the person feels comfortable with, says the NEABPD. Some symptoms are easier to treat than others, and often treatment will also focus on other disorders that might be present, such as anxiety, PTSD, or depression. Two common types of treatment are Dialectical behavior therapy (DBT), a problem-solving approach that teaches patients specific skills to help them control intense emotions and cut down on self-destructive behavior; and Mentalization-based therapy (MBT), a talk therapy that helps people focus on their own mental states as well as understand what other people are thinking and feeling.
Are There Specific Medications for Borderline Personality Disorder?
According to the expert organizations, there’s no one specific medication to treat BPD. But sometimes a patient’s doctor will recommend medications to target certain symptoms such as anxiety, depression, and mood swings. It’s important, of course, to work closely with a doctor, since different meds can bring on side effects. The NIMH has a good primer on a wide range of mental-health meds here.
Want to know more? The NEABPD is an excellent resource, with an extensive media library, podcasts, and other information.