Often misunderstood, borderline personality disorder (BPD) can be a difficult diagnosis to contend with on your own. Marked by a pattern of mood swings and unstable self-image, BPD often results in impulsive behavior and difficulties with relationships. However, awareness and understanding of BPD is growing, and there is help for those who may be struggling with it. Keep reading for five important things you should know about this disorder and how it affects those who have it.
By Anna Hill
Dr. Michael Sigsworth Psychiatrist, Erlanger Behavioral Health
1. Borderline personality disorder (BPD) can occur simultaneously with other personality or mood disorders.
Borderline personality disorder shares many symptoms with other disorders and can occur in people at the same time as other disorders as well. “BPD can co-occur with depression, bipolar disorder, and PTSD, although it is important for a clinician to have information regarding the frequency, severity, and duration of symptoms for a proper diagnosis,” says Kristin Smith, a licensed professional counselor with Parkridge Valley Hospital. BPD can also coincide with personality disorders within its own family of disorders, which include narcissistic, histrionic, antisocial, and schizotypal personality disorders.
Though many of these disorders share symptoms, there are things that set them apart as well. The defining symptoms of BPD include impulsivity and reckless behavior; feelings of emptiness or
a fear of abandonment; rapid, moment-to-moment mood swings; difficulty sustaining relationships; and difficulties with self-image that cause erratic decision-making. According to Dr. Marie Beasley, a psychiatrist at Riverview Psychiatry, BPD is commonly misdiagnosed as bipolar disorder, though in some cases, both disorders might be present. “Bipolar disorder is a chemical imbalance that causes both episodes of depression and manic or hypomanic episodes,” she says. “These are high moods that last persistently for several days in a row and also occur with other classic symptoms.” If someone’s mood shifts between extremes within the span of a day or, for some, even in the span of hours, it’s indicative of BPD, not bipolar disorder.
2. BPD is usually diagnosed in late adolescence or early adulthood.
Though symptoms frequently begin to manifest in someone’s adolescent years, a diagnosis often isn’t made until someone reaches adulthood. Changing moods and impulsivity aren’t uncommon behaviors in teenagers, as adolescence is an intense and constantly changing stage in life; however, when these behaviors become extreme and/or persist into adulthood, it can be a sign of a disorder. “Symptoms can start in adolescence as traits of borderline personality disorder, and they frequently improve into adulthood. However, in some cases, symptoms can worsen or remain into adulthood as borderline personality disorder,” explains Dr. Michael Sigsworth, a psychiatrist with Erlanger Behavioral Health. A diagnosis of BPD also tends to be much more likely to occur in certain demographics. “It’s much more prevalent in women, as high as 4:1 versus men in most studies. Prevalence also tends to decrease after age 40,” Beasley tells us.
3. Childhood trauma or neglect can heighten someone’s risk of developing BPD.
Like many conditions, BPD has a genetic risk factor. If a family member has the disorder, that elevates a person’s predisposition toward developing it as well. Difficulties or instability in childhood may also increase someone’s likelihood of having BPD later in life. “People with poor attachment to caregivers at an early age or those who were abandoned or had numerous home placements at a young age are at an elevated risk,” explains Smith.
Trauma early in life is also viewed as a risk for developing the disorder; in fact, BPD is commonly associated with post-traumatic stress disorder (PTSD). “While trauma is not always present in the history of someone with BPD, it is very commonly associated with physical, verbal, or sexual abuse; neglect; early exposure to substance abuse in a caregiver; or poor family boundaries,” says Beasley. Trauma can interfere with a person’s formative years in that it prevents them from establishing their own identity and building relationships on trust, which can manifest into key symptoms of BPD.
4. BPD can greatly influence the quality of someone’s relationships and day-to-day life.
Borderline personality disorder can be an incredibly difficult disorder to cope with, especially on your own. Unfortunately, due to some perceptions of the disorder, there can be a lot of shame surrounding a diagnosis of it. “When you have BPD, every day can feel like you are in crisis. Intense emotions and subsequent reactions to these can affect you negatively at work and at home,” explains Smith. It can also do a lot of damage to your self-image and relationships of every kind, as well as impact your ability to succeed in your career and in life.
According to Sigsworth, people with BPD can struggle to adapt to changing environments and situations. “Individuals with severe personality disorders may have one or two gears that they are trying to navigate life in, instead of a full range that a neurotypical person might have, and that can be very challenging,” he says. “It can be difficult to sustain long-term relationships and can lead to worsening anxiety and depressive symptoms.” Of course, all personality disorders exist on a spectrum, and some people with the disorder may experience these symptoms more severely than others.
5. Treatment usually involves an individualized approach.
There are several different approaches to treating BPD, though what is most effective will be very dependent on the needs of the individual. One of the foremost treatments for BPD is dialectical behavioral therapy (DBT), which is a subset of the more widely known cognitive behavioral therapy. “This kind of therapy helps the patient find the middle ground and helps build connections between the emotional mind and the logical mind to make wise and informed decisions,” explains Sigsworth. This can help the patient avoid returning to destructive patterns of decision-making when it comes to their daily life and their relationships. Some medications might also be prescribed, such as mood stabilizers, antidepressants, and anti-anxiety medications, in order to alleviate some symptoms. Furthermore, addressing some underlying conditions, such as insomnia or substance abuse, might also be a part of the treatment plan. Ultimately, this plan relies heavily on what the individual needs to manage their symptoms.
Borderline personality disorder has been stigmatized and misunderstood in the past, but fortunately, understanding of it is growing. If you or someone you know thinks that they might be struggling with BPD, don’t hesitate to seek help. If you feel like you have nowhere to turn, call the Substance Abuse and Mental Health Services Administration (SAMHSA) National Helpline at 1-800-662-HELP (4357) for confidential, 24/7 help. HS