Borderline Personality Disorder explained
BPD is a spectrum of behavioural disorders marked by emotional instability, distorted sense of self, unstable relationships, struggles with intimacy, empathy. Patients consult therapists for their own BPD, or their partner’s. Living with someone with BPD is frequently challenging and emotionally exhausting. BPD is a prime example of Personality Disorders (ASD, BPD, paranoia, narcissism, etc.) which tend to be long to heal, involving multi-pronged protocols.
Borderline Personality Disorder explained through any one prism is difficult and we will use different ones to get a better sense. BPD as a disorder it is still relatively new and researched. BPD is three times likelier to be found in women though ongoing debate focuses on whether this reflects prevalence in the real world, or current diagnostic protocols. Borderline Personality Disorder explained through a genderist lens may make sense statistically but not consequential enough to define it.
It is also highly associated with sexual abuse, an aspect of BPD that has been the topic of extensive research and one that may tilt real world BPD prevalence further back towards women as girls are generally over-targeted for sexual abuse compared to boys. Borderline Personality Disorder explained through the prism of sexual abuse makes some limited sense statistically also but we should follow a more rigorous and holistic definition.
The “five of nine” criteria for Borderline Personality Disorder
The American Psychiatry Association (APA) worked to define more rigorously what Borderline Personality Disorder is. The APA uses a set of 9 criteria, scoring 5 or more of which results in a higher chance of / diagnostic of BPD. Borderline Personality Disorder explained through these “5 out of 9” makes by far the most sense:
- Fear of abandonment, whether imagined or real. Paradoxical behaviour in relations (push away/bring in).
- Fraught, unstable personal relations, oscillating between extremes (neglectful / adulation)
- Painful and/or unstable sense of self-worth (dejection/narcissism). Lack of inner anchor, tastes, and/or guiding principle.
- Risk-taking, inability to weigh up mid-term consequences in at least two areas (ex. Drugs, shopping, sex, bingeing, dangerous driving etc.)
- Suicidal thoughts, recurring speech/actions around self-harm, threatening suicide, self-mutilation.
- Hyper reactivity in moods, higher than normative levels of strong emotions from elation to irritability to depression. Defensiveness.
- Feeling “empty” on a regular/structural basis. Outwardly, observers sometimes comment on BPD patients visibly lacking a “core”.
- Rage and anger, frequent issues with anger management, inability to “let go” of minor things. Anger as a typical emotion, a common resort.
- Delusive ideation, and/or stress-induced paranoid feelings, substantial dissociative symptoms.
Borderline Personality Disorder explained as essentially a paradoxical ail makes sense also: Contradictory and conflictual rapports with their loved ones, over extended periods of time. BPD patients often oscillate wildly between personas and moods. In turn highly engaging, warm, friendly, seductive, in turn defensive, callous, withdrawn, sullen.
Borderline Personality Disorder patients often do odd things, or act rigidly. BPD Patients report significant, long-term impairments to their sense of intimacy or empathy. Deceitfulness, repeated lying. Irresponsibility and manipulativeness. Callousness, risk-taking. Failure to honor previous commitments. Inability to understand basic expectations for respectful behavior. Changeable or irrational behavior. Unpredictability in words or actions, breaking trust. Inability to enjoy calm, grounded being. High variance between their public and private demeanours. High defensiveness and hyper-vigilance.
Cognitively, BPD patients struggle taking on messages or situations in their entirety. Since their inner life is quite loudly busy with inner talk and script-rumination, their “bandwidth” is lower to acquire real-life information (facts, feelings, emotions, etc.) This structural tunnel vision is also the source of some of their recurring issues. Borderline Personality Disorder is hard to define and easier to “see” or experience. The APA itself is still refining the diagnostic criteria they are using to identify BPD.
As far as current research goes, seem to borrow from neurology as much as environmental factors. There has been a certain level of doubt about the very existence of BPD for years, and a certain stigma attached to it. BPD is now much better understood and regular therapy is proven to enhance patient outcomes.
“Catch 22’s” and paradoxical boundaries
BPD is marked by paradox. BPD patients deep down crave for intimacy but find themselves unable to connect or empathise. The result for their close ones, is often painful, paradoxical and emotionally draining. Children raised by a BPD parent systematically report issues with emotional control, boundaries, self-worth, and many other. Borderline Personality Disorder explained through paradox also makes a lot of sense.
BPD patients are emotionally exhausting for their partners, and therapy often needs to consider that, and refer the partner to a different therapist. Highly aware politically and leaning towards narcissism, BPD people can however not manipulate as well as a narcissists or ASPD as their behaviour and inner states are too unstable.
BPD can be remote emotionally, struggling with empathy, over-reacting, and repeating an exhausting cycle of “pushing out” their partner (by openly doing something reprehensible) then “pulling in” (by suddenly being overly friendly and acting “nice”).
The end result is relationships fraught with seemingly pointless conflict cycles, and little hope of change. Hyper-vigilance as a result of seemingly never-ending series of cycles. Incapacity to objectively provide enough trust and care in the relationship. BPD patients can also be quite defensive and often unwilling to do therapy, brought by their partners.
BPD patients often struggle with a clear idea of their self-image and their self-worth. As a result they often seek out validation in others, rather than internal principle. This lack of clarity and self worth, coupled to this unhealthy over-reliance on others can cause a considerable amount of trouble and hurt.
BPD and dangerous behaviors
BPD patients typically engage in dangerous behaviours that can range from overeating to self-harm to drug abuse, all the way to violent lifestyles (verbal, physical for men particularly). Borderline Personality Disorder explained along propensity for dangerous behaviour is one of its most visual obvious manifestations.
BPD patients often struggle with feelings of emptiness, which explains some of these behaviors to a point. Often described as lacking in self awareness the patient often struggles with feelings of abandonment, depression and loneliness he/she needs diversion from.
BPD patients tend to “ruminate” considerably their inner thoughts, divorcing them from grounded reality. The outlandishness of their behavior is explained in part by that drive to divert their thoughts. In time however, their cerebral ruminations gradually erase the outline of real-life experience and memories. BPD patients live in a different cognitive world marked by high degree of bias and filter.
Their mind tends to be overactive and overanalyzing, further removing their chance at authentic living. Self-censoring and highly aware of political context they struggle to share their thoughts or take an honest interest in someone’s headspace or opinion.
They can convince themselves of a variety of things, in order to stay in that over-analysing “script” and justify somehow their next acting out. BPD’s are often “transactional”, aware of the positive things they do and feel intense hurt if they are not complimented enough. In fights they quickly list the list of positive things they do even if they are unrelated to the topic at hand, making problem solving difficult.
Individuals suffering from Borderline Personality Disorder often live in a stage of hyper-vigilance, ascribing disproportionate importance to some things (they can for ex. be absolutely mortified by a simple argument in public) but think little of more serious things (lying, deceiving, manipulating).
Borderline Personality Disorder explained through the prism of the exhaustion they cause to their loved ones in another simple, visual way to get a sense for it. The sheer repetition of outlandish behaviours, whatever solution has been discussed or agreement reached raises resentment and hurt, breaks emotional trust. Without resolution partners often need to take “time off” from each other in acute situations.
BPD diagnostic and comorbidities
Borderline Personality Disorder can be an all-consuming disorder, that requires often urgent and lengthy intervention. BPD implies a variety of comorbidities, some direct (10% of overall suicide are related to Borderline Personality Disorder) some indirect in the form of related disorders. BPD is broadly accepted to be one a difficult and damaging class of PD (Personality Disorders).
Borderline Personality Disorder explained across comorbidity:
- NPD Narcissistic Personality Disorder
- High degree of relationship conflict and unsatisfaction
- Mood disorders, similar in some ways to bipolar and depression
- Substance abuse
- Higher than average occurrence of unwanted pregnancy, unsafe sex & STD’s
- Other personality disorders such as antisocial and dependent personality disorder
- Eating disorders including anorexia nervosa and bulimia
- ADHD
- Dissociative disorders
