Borderline Personality Disorder: Dispelling Misconceptions and Understanding Management

Did you know that Borderline Personality Disorder (BPD) impacts between 2% and 5% of Australians? Despite its prevalence, BPD still faces significant stigma and misunderstanding. In this post, we're diving into BPD to help shed light on this often-misunderstood condition. We'll explore what BPD is, what triggers its symptoms, debunk some common myths, and offer insights into managing and finding support for those affected.

WHAT IS BORDERLINE PERSONALITY DISORDER (BPD)?

People living with Borderline Personality Disorder (BPD) experience overwhelming negative emotions which cause significant challenges for them in relationships, self-care, and functioning across various aspects of life. These emotions are often driven by a very poor self-image and negative beliefs they hold about themselves. These beliefs (often referred to as ‘schemas’ or ‘core beliefs’) are quite entrenched and often stem from childhood trauma (eg, abuse, abandonment, neglect) which impeded the development of a healthy sense of self-worth, value, and security. Research suggests there are also genetic and neurobiological factors that lead to the development of BPD.

Recognising the symptoms of BPD is vital for intervention and support, and a person must show at least five of the following signs for a diagnosis according to the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5):

Fear of abandonment: Some people with BPD may feel intense fear of being abandoned by others, which can lead them to go to great lengths to avoid it.
Relationship challenges: People with BPD might struggle with relationships, alternating between extreme closeness and distancing in their connections with others.
Uncertain identity: Individuals with BPD may have an inconsistent sense of who they are, which can lead to changes in their goals, values, or relationships.
Impulsivity: Some individuals with BPD may engage in behaviours like substance abuse, binge eating, or risky sexual behaviour and driving.
Self-harm or suicidal behaviour: People with BPD may engage in self-harming behaviours or thoughts of suicide, especially during times of distress.
Emotional shifts: Individuals with BPD may experience noticeable shifts in mood, with emotions like dysphoria, irritability, or anxiety lasting between a few hours to a few days.
Feelings of emptiness: Some people with BPD may describe feeling empty or emotionally numb, which may be accompanied by feelings of boredom and loneliness.
Difficulty managing frustration: Individuals with BPD may struggle with frustrations or may experience frustrations more strongly than others.
Paranoia or dissociation: During times of stress, some individuals with BPD may experience brief episodes of feeling disconnected from themselves or from reality, or having paranoid thoughts.

TRIGGERS OF BPD SYMPTOMS

There are a range of factors that can trigger negative internal thoughts or beliefs that reinforce self-perceptions of being unworthy or unlovable. They can increase emotional distress and include the following:

Interpersonal conflict: Arguments or disagreements can trigger uncomfortable emotional reactions and feelings of inadequacy.
Perceived abandonment or rejection: Situations where individuals feel abandoned, rejected, or ignored by loved ones or friends can evoke feelings of fear and insecurity.
Stressful life events: Major life changes, such as the loss of a job, divorce, or separation can overwhelm individuals with BPD.
Personal and professional challenges: Any situation that may evoke one’s sense of vulnerability such as receiving criticism or facing failure, can trigger feelings of shame, worthlessness, or self-dislike.
Substance abuse: Substance abuse can affect one’s perception of situations, leading to negative and distorted interpretations, emotional upheaval, and impulsive behaviour.
Social situations: Overwhelming or crowded social environments, particularly those involving unfamiliar people or social pressures can trigger anxiety and feelings of inadequacy or alienation.
Reminders of trauma: Reminders of past traumatic experiences can provoke unsettling emotional reactions and re-traumatisation.

It's important to note that while these various triggers may provoke symptoms of BPD, not everyone with BPD will respond in the same way to these situations.

COMMON MYTHS ABOUT BPD

BPD is often surrounded by misconceptions that contribute to stigma and misunderstanding. Here are some common ones:

Myth 1: People with BPD are attention-seekers

The misconception that people with BPD are attention-seekers overlooks the underlying emotional turmoil they experience. Rather than seeking attention for the sake of it, individuals with BPD often exhibit behaviours driven by a profound need for validation and support. These actions stem from genuine distress and challenges in regulating emotions, rather than a desire to draw attention to themselves.

Myth 2: People with BPD are manipulative

This myth fails to acknowledge the underlying struggles BPD individuals face. While they may engage in behaviours that others misinterpret as manipulative or deceitful, such actions often stem from difficulties in regulating emotions. These behaviours are not driven by malicious intent, but via coping mechanisms to protect oneself from perceived threats to their emotional wellbeing and stability in relationships. Compassion and understanding are vital in supporting individuals with BPD.

Myth 3: BPD is just extreme moodiness

While shifts in mood is a common symptom of BPD, this statement oversimplifies the complex nature of the condition. BPD involves pervasive patterns of irregularities in mood, self-image, and relationships, extending beyond the typical perspective of ‘moodiness’. Individuals with BPD experience emotional dysregulation which they fight to cope with, often triggered by external stressors that significantly impact their daily functioning. This myth undermines the severity and depth of the condition, hindering accurate understanding and appropriate support for those affected.

Myth 4: BPD only affects women

While it's true that BPD is diagnosed more frequently in women, it can affect people of any gender. Cultural stereotypes and biases may contribute to underdiagnosis or misdiagnosis of BPD in men. It's essential to recognise that BPD does not discriminate based on gender.

Myth 5: BPD is just a phase, and people will grow out of it

BPD is a chronic mental health condition that typically requires long-term management. While some individuals may experience periods of remission or symptom improvement, BPD does not simply disappear over time. With appropriate treatment and support, individuals with BPD can learn to cope with their symptoms effectively.

Myth 6: People with BPD are dangerous or violent

Violence is not an inherent characteristic of BPD. While individuals with BPD may struggle with emotional dysregulation and impulsivity, this does not mean they are dangerous. Sensationalised media portrayals often contribute to the misconception that individuals with BPD are violent, leading to further stigma and discrimination.

TREATMENT OPTIONS AND MANAGEMENT FOR BPD

With the right therapy, individuals with BPD can learn to manage their symptoms effectively and lead fulfilling lives. Effective treatment for BPD often involves a combination of psychological therapy, medication, and support, and it's essential to seek help from qualified mental health professionals who specialise in this condition. Some common treatment modalities include:

1. Cognitive-Behaviour Therapy (CBT): CBT helps individuals identify and change negative thought patterns and behaviours that contribute to emotional distress. In particular, schema-focused therapy within the CBT framework addresses underlying negative core beliefs which developed through childhood.

2. Dialectical Behaviour Therapy (DBT): DBT is a type of cognitive-behaviour therapy that focuses on teaching a person skills to manage their emotions, improve interpersonal relationships, and tolerate distress.

3. Medication: While there are no specific medications that target BPD, certain agents like antidepressants, mood stabilisers, or antipsychotics may be prescribed to target specific symptoms such as depression, anxiety, or impulsivity.

4. Supportive Environment: Creating a supportive and validating environment is imperative for individuals with BPD. Family therapy can provide education and guidance for loved ones on how to effectively help someone with BPD. Support groups can also provide validation, understanding, and encouragement from peers who are facing similar challenges.

5. Self-Care: Practising self-care strategies such as mindfulness, exercise, and maintaining a healthy lifestyle can help individuals with BPD manage stress and regulate their emotions.

For more information about BPD, including support groups and resources for understanding and managing this condition, here are some helpful links:

Dr. Carissa Coulston-Parkinson is a Clinical Psychologist with specialist knowledge in the areas of depression, bipolar disorder, anxiety, schizophrenia, intellectual disability, personality disorders, traumatic brain injury and neurological conditions.

SANE provides a range of free telephone and online support services for people over 18 years of age with complex mental health needs and their family, friends and carers. We offer different types and levels of support so you can find what works for you. Choose from counselling, peer support, online groups and events, 24/7 community forums, and online information and resources. Learn more at sane.org/get-support.