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Misunderstood and Stigmatized: Borderline Personality Disorder

Borderline Personality Disorder (BPD) is often considered a mental disorder that is extremely difficult to diagnose and treat. It is characterized by perennial instability in moods, behaviors, and relationships. Its symptoms may vary from one person to another. However, one of the most fundamental traits of a person suffering from BPD is an extreme fear of abandonment. 


The DSM-5 (Diagnostic and Statistical Manual of Mental Disorders) defines BPD as a pattern of unstable and intense interpersonal relationships characterized by alternating between the extremes of idealization and devaluation. 


According to the Mayo Clinic, BPD has several other symptoms. These include an inability to regulate emotions, lack of distress management skills, intense anger or rage issues, tantrum-throwing behaviors, widespread changes in moods, perpetual feelings of emptiness or brokenness and despair, and holding extreme views about people and relationships (splitting). 


Additionally, in several cases, people with BPD also develop suicidal tendencies. They may also engage in risk-taking behaviors such as indulging in drug consumption, unsafe sex, and excessive speeding of vehicles. This is precisely why the suicide rate among people with BPD is exponentially high. According to the New York Presbyterian, 70% of people with BPD will attempt suicide at least once in their lifetime. Furthermore, about 10% are likely to complete the act. 


Due to the complexity of this disorder and its chronically high suicide rates, BPD has been stigmatized and marginalized in the medical health care system. In most cases, a person with BPD also suffers from other mental health issues. For instance, many of its symptoms coincide with those of Complex Post Traumatic Stress Disorder (C-PTSD) and Narcissistic Personality Disorder (NPD). The range of its symptoms and its striking similarity to other mental disorders has made its diagnosis very difficult. 


Moreover, another aspect that has contributed significantly to its stigmatization is its emotional volatility. People with BPD have great difficulty dealing with emotions. As a result, their families and friends always have a sense of walking on eggshells around them. Additionally, after years of treatment, there is a considerable financial burden on many such families. However, there have been several instances where a person with BPD has been misdiagnosed. As a result, many do not receive timely and appropriate treatments for it.


Despite its complexity and stigma, the quest for understanding what causes BPD and how one can manage its symptoms has led to many vital contributions in the field of Psychology and Psychiatry. The American Psychologist Dr. Marsha Linehan has made the most pioneering contribution. 


Marsha Linehan opened up publically about her struggle with BPD for the first time at one of her Lectures in 2011. Having grown up with suicidal tendencies and an extremely confused and distorted self-image, she believed learning new behaviors was fundamental in bringing about change. She was convinced that deliberate and repeated changes in behavior could significantly improve the personalities of people with BPD. 

Linehan has been credited with introducing Dialectical Behavioural Therapy (DBT) in BPD. DBT combines mindfulness, emotional regulation through breathing exercises, and distress management through radical acceptance. DBT is now considered the most beneficial approach to treating BPD.  A study by the University of Washington in the mid-1980s revealed a significant reduction in suicide rates among patients with BPD.


Many other therapeutic approaches, such as Cognitive Behavioural Therapy (CBT) and Schema Therapy, have proven far less effective in treating BPD.


It is essential to mention here that the exact cause of BPD has largely remained unknown. Some researchers point out that childhood trauma, such as neglect or abuse in the hands of primary caregivers, could be the major cause. Others have claimed that some people are genetically and biologically prone to develop BPD. Yet others have suggested that combining the two leads someone to create BPD.


Unfortunately, without any conclusive data, it is difficult to ascertain the exact cause of the disorder. For several decades, people with BPD have been labeled “attention-seeking” and “tantrum-throwing.” Frequent and, in some cases, violent outbursts of anger have led many to believe they can be potentially dangerous. Their hypersensitivity to emotions and accompanied by a constant oscillation between hope and despair, can leave family members and therapists frustrated.


Irish Clinical Psychologist Keith Gaynor states that when it comes to BPD, individual therapy can prove to be counter-productive. This is essential because it leads to frequent therapist burnout. Therefore, he believes group therapy is far more beneficial for its treatment.


Unfortunately, people with BPD are highly aware of their emotions. It is common to find that many people with BPD express guilt and shame for their rage and intense crying. What underlies their incapacity to regulate their emotions is a feeling of grief and emptiness. The sheer intensity of emotions that they are overwhelmed with on day to day basis (sometimes even on an hourly basis) is exhausting and heartbreaking. 


As with any other chronic mental disorder, most people with BPD have experienced trauma and grief at a very early stage. Their vulnerability to the extremities of emotions leaves them wounded and aggrieved at every step. As Marsha Linehan once stated, “People with BPD are like people with third-degree burns over 90% of their bodies.  Lacking emotional skin, they feel agony at the slightest touch or movement.”

Edited by: Whitney Edna Ibe

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Tags: #disorder #mental health #borderline personality


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