Borderline Personality Disorder

What is Borderline Personality Disorder?

Borderline Personality Disorder or BPD is a mental health condition that is characterized by emotional dysregulation, an unstable or lack of sense of self, difficulties with interpersonal relationships, and heightened sensitivity to perceived or real rejection or abandonment. The prevalence of BPD is thought to be around about 6% of the general population.

What causes Borderline Personality Disorder?

When looking at the model of structural dissociation, BPD seems to be caused by complex childhood trauma and attachment injury or attachment wounding. This would be consistent with most people with BPD having some dissociative amnesia during childhood. The symptoms and the behaviors are the results of a survival mechanism for trying to survive complex trauma in childhood. Take for example, the unstable or lack of sense of self. This is caused by traumatic dissociation and parts activity, commonly found in people with complex trauma. Another example is the heightened sensitivity to perceived or real rejection or abandonment. In regards to attachment injury, this would have been important in recognizing danger in traumatic situations.

What are the signs and symptoms of Borderline Personality Disorder?

-Frantic efforts to avoid real or imagined abandonment.

‍Examples: Becoming highly distressed when someone cancels plans, making drastic attempts to keep someone from leaving a relationship, preemptively emotionally withdrawing to reduce the anticipated pain of abandonment or rejection, excessively seeking reassurance; or becoming angry when someone appears distant.

-A pattern of unstable and intense interpersonal relationships by alternating between extreme idealization and devaluation.

Examples: Rapidly shifting from viewing someone as wonderful to viewing them as terrible, abruptly ending relationships following conflict, quickly entering relationships that feel intense and are shortly lived, or dramatic shifts about how we view someone without any obvious behavioral changes.

-Unstable self-image or sense of self.

Examples: Frequently changing plans for the future, feeling like identity changes based on the situation and who is present, difficulty identifying preferences because of automatically taking up someone else’s preferences, internal conflict about goals and values, or frequently changing career, educational, or life goals.

-Impulsivity in at least two areas that are potentially self-damaging.

Examples: Substance use, impulsive spending, gambling, binge eating, unsafe sexual behavior, or abruptly making major life decisions without considering the consequences.

-Recurrent suicidal behavior, gestures, threats, or self-mutilating behavior.

Examples: Suicide attempts, recurrent suicidal threats, internal suicidal fantasies, or self-harm through cutting, burning, etc.

-Affect instability.

Examples: Rapid mood shifts following interpersonal triggers, disproportionate responses to perceived rejection, emotional flooding followed by rapid shifts to baseline, or abrupt internal transitions from attachment/security to fear or rage.

-Chronic feelings of emptiness.

Examples: Feeling empty or hollow, repeatedly seeking stimulation or relationships to escape emptiness, difficulty tolerating being alone, constantly feeling like something is fundamentally missing from your life, or chronically feeling blank, numb, or unreal.

-Inappropriate and intense anger.

Examples: Frequent arguments, explosive anger, rumination about perceived mistreatment, rapid internal escalation in response to perceived rejection, or self-directed anger replacing outwardly expressed anger.

-Transient, stress-related paranoia or severe dissociation.

Examples: Memory gaps associated with stressful situations, internally questioning everyone’s motives, becoming suspicious of others conspiring against them during times of stress, feeling detached from one’s body, depersonalization/derealization, or experiencing oneself as “not me.”

What are some treatment options for Borderline Personality Disorder?

One of the most effective treatments for BPD is Dialectical Behavioral Therapy or DBT. It is especially helpful in helping to stabilize our lives and help us better respond to the events in our lives. Oftentimes, people with BPD can feel like they are spinning their wheels and DBT is designed to help with that by focusing on distress tolerance, emotional dysregulation, mindfulness, and interpersonal skills. For dealing with the complex trauma elements, modalities like Eye Movement Desensitization and Reprocessing Therapy (EMDR), brainspotting, or Cognitive Processing Therapy (CPT) can be helpful.

If you are struggling with Borderline Personality Disorder, reach out to us to see how we can help!