What Is Borderline Personality Disorder?

In 1980, with the publication of the DSM-III (Diagnostic and Statistical Manual of Mental Disorders), Borderline Personality Disorder (BPD) was officially standardized as a diagnosable condition.  While it had been studied long before then, it has only been in the last few decades that a more coherent understanding of the disorder could be assembled.  But what does it mean to be a borderline?

The mind of a borderline is, typically, characterized centrally by its rapid and frequent changes in emotional state.  Unlike the changes in mental state found in individuals with Bipolar and Cyclothymic Disorders, the emotional fluctuations are usually far more chaotic.  While the reasons are complex and not fully understood, perception seems to be a primary cause.

Those with BPD seem to have difficulty separating where the self ends and others begin.  A harmless comment or critique can be interpreted as a cutting remark or verbal attack.  This can often cause unpredictable reactions including, but not limited to withdrawal and a sense of self-loathing or an apparent demonization of the ‘offending’ person.  In the case of the former, the person will internalize the feeling, feeling that they are the cause of the event or comment that set off the change in mood.  In the later, it is the other person who receives the blame and are often judged solely on the event in question.

Both of these instances relate to what is known as splitting, or all-or-nothing thinking.  The mind of someone with BPD often thinks in black and white.  Something is seen as either all good or all bad.  If something new is brought to the individuals attention, the mind has difficulty integrating the two conflicting pieces of evidence and the stronger and/or most recent bit overpowers the other.  Someone with BPD may see another, or even themselves, as someone to be idolized one day only to be vilified the next.  The conflict between these two extremes is frequently a source of anxiety for the individual.  Anxiety that, because of the innate difficulty in separating the ideas of the self from those of others become a source of interpersonal turmoil.  If someone else seems to be the cause of such anxiety, then why should they be trusted or even respected?  Similarly, if another appears to be the source of seemingly disparaging remarks or actions, then why seek to continue the relationship?

But those with BPD generally need the very interpersonal relationships that can become a source of fear, anger and depression.  Whether the person feels they are unworthy of the affection of others, sees it as an attempt to control them or simply has difficulty dealing with the inner conflict brought on by the all-or-nothing mode of thinking, the end result is often the same.  A deep fear that they will be, in some way, alone – and to be alone with thoughts that seem unpredictable even to the sufferer can be overwhelming.

When looking at themselves, those with BPD will see something that can be as tumultuous as their views on others.  Who and what they see themselves as can change just as easily.  A feeling of worthlessness can be suddenly changed into elation at what would normally be seen as a small occurrence.  Likewise, a perceived criticism can lead to the individual being pulled down into a depression that they cannot see a way out of.

Compulsiveness is often another trademark of the Borderline, frequently in a self damaging way.  From compulsive purchases to drug and alcohol addiction, from the starting and stopping of hobbies to self mutilation.  These feelings are rarely fully understood by the individual but can be as difficult to ignore as the split thinking seen elsewhere.

Not all of these are seen in everyone who have been diagnosed or are thought to have BPD and other related behaviors are looked at when a diagnosis is considered.  While a diagnosis can only be given by a mental health professional, the site BPDCentral provides both a primary diagnostic list as well as quotes from those who have the condition.  BPD is also well known for its frequent comorbidities, conditions held at the same time.  These can range from Narcissistic Personality Disorder to anxiety disorders, eating disorders and others.

BPD is estimated to be found in 1 to 3% of the US population and is primarily seen in young women, with a ratio of roughly three to one.  However the reason for this discrepancy is yet to be fully understood.

There is no single agreed upon cause for BPD and it may very well require a series of interrelating conditions for it to manifest itself.  The most commonly attributed cause is childhood abuse or neglect.  There is evidence to suggest that BPD can run in families, but it is uncertain if this is because of genetics or a more psychosocial cause, or even a combination there of.  The idea of BPD being a learned condition has been around for quite some time and it does seem that untreated borderlines do have a higher likelihood to raise another generation of borderlines.  But like so many mental health conditions, the relation between all of these may be more crucial than any single cause could ever be.

Thankfully the condition is seen as treatable, if potentially difficult.  About a third of those diagnosed can achieve ‘remission’ within a year or two of treatment and within six over half generally find the mental stability they seek.  There are no quick fixes and the Cochrane Collaboration -an independent group that looks at both individual studies and the cumulative effects of multiple studies- has found no evidence to suggest that the condition itself can be treated with medication, though certain symptoms can be successfully treated with them.  While multiple techniques are used in the treatment of BPD, a review published in 2010 suggests that dialectical behavior therapy and mentalization-based therapy have the highest success rates.

Unfortunately, the understanding of the condition by the general public is weak at best and it has been mischaracterized in popular fiction on more than one occasion.  Those who know people with BPD may avoid them out of confusion or frustration and even some mental health professionals may prefer not to treat this condition due to the potential difficulty involved.  But these only allow the cycle to continue.  It can only be through a mutual understanding that the sufferer, their loved ones, and those treating the condition can reach the middle ground needed for all involved.

Many thanks to BPDCentral and The Mayo Clinic for their contributions to this article.

References used in the preparation of this article:

Stoffers J, Völlm BA, Rücker G, Timmer A, Huband N, Lieb K (2010). Lieb, Klaus. ed. “Pharmacological interventions for borderline personality disorder”. Cochrane Database Syst Rev (6): CD005653. doi:10.1002/14651858.CD005653.pub2. PMID 20556762

Paris, J. (2010). “Effectiveness of Different Psychotherapy Approaches in the Treatment of Borderline Personality Disorder”. Current Psychiatry Reports 12 (1): 56–60. doi:10.1007/s11920-009-0083-0. PMID 20425311

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Posted by on October 5, 2012. Filed under SCI/TECH/HOME/TRAVEL. You can follow any responses to this entry through the RSS 2.0. Both comments and pings are currently closed.
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6 Responses to What Is Borderline Personality Disorder?

  1. Beowulf

    October 5, 2012 at 1:47 pm

    I can tell you from experience if you have a borderline in your life get as far away as you can because the one’s I’ve known are fucking nuts man. I was married to one and you never knew what you were getting from Monday thru Sunday, it was either up, or down, or trying to die by cutting, drinking, binge eating, puking, and other stuff. They can’t keep solid friends because they treat them like shit one day and then gold the next. Nothing predictable and nothing safe. Find one? Run like hell……

  2. Bill Formby

    October 5, 2012 at 3:26 pm

    Well done Chris. It is important that people learn to distinguish various mental health disorders from one another. It is still one of the most misunderstood areas of human behavior we have today in society.

  3. Erin Nanasi

    October 5, 2012 at 8:21 pm

    As a recovered borderline, I really appreciate this article. I’m visiting a lot of my childhood at the moment, and as healthy as I am today, it’s still hard to go back to the defining moments that “created” my BPD. Thank you for including the information on BPD possibly being hereditary. As to Beowulf, BPD’s are hard to be with, however I am thankful that my husband, who has been with me for 13 years, never thought to “run like hell.” He stayed and worked with me, read the books and went to therapy because he knew, underneath it all, was the woman I am today. Thank you so much for this, Chris.

    • Bill Formby

      October 6, 2012 at 10:13 pm

      Erin, part of Beowulf’s problem (and many others) is that often they misunderstand what or who they are dealing with thing it is BPD. I deal with a lot of people who self diagnose themselves with BPD when they are really Bi Polar or sociopaths, or, more than likely poly addicts, any of which can can make anyone’s life miserable.

  4. Baker48

    October 8, 2012 at 6:32 pm

    With apologies to Mrs. Nanasi, there is no cure for BPD, only various medications, therapy, as you mention, and other strategies designed to limit the reach of this illness. Then again you probably know these things but I have to tell you, my wife, a BPD, sometimes goes off the deep end. Just last week she quit her job, for no reason other than wanting more time to spend in her garden. We needed that money but BPD’s don’t care about that, because their behavior is impulsive and ill-considered. She will seize on things, usually news items or neighborhood disputes, and become obsessed with them and it’s during these times I’m the most concerned because that’s when she has the potential for self-mutilation, deep depression, uncontrolled weeping and other unhappy things. BPD is not a disease to be taken lightly. Kudos to your hubby for hanging in. My wife and I are celebrating our 20th anniversary Monday, but right now she’s obsessing over which neighbors to invite to a party we’re not going to have.

    • Erin Nanasi

      October 19, 2012 at 2:44 pm

      And with all due respect to you, sir, I am here, typing this as a recovered borderline. I used to think BPD was like alcoholism-you could never truly be “cured,” you would just resist the urges. I was wrong.

      Your wife sounds like perhaps she has not worked the dialectic therapy, probably has been misdiagnosed a few times, and may not even be aware that there are people like me around. People who battled BPD and won. Bad therapists can frighten someone into believing no therapist can help. That is in fact not true. We found a fantastic therapist who only works with borderlines, and I learned the coping skills, I learned how to find my wise mind and I am a happy, healthy, whole person who delights in being well.

      And in reference to your comment that BPD is not a disease to be taken lightly, I agree 100%, and only wish the psychiatric community, along with the majority of society, agreed as well. I no longer self-harm, nor do I even think about it, I am a healthy weight and my relationships are meaningful, well balanced and realistic. I would ask you to please not generalize when speaking about BPD: there are quite a few recovered/recovering borderlines around, and we are proud of our success.

      I plan to show your “kudos to your hubby for hanging in” comment to my husband. My guess is his response will be something along the lines of he didn’t “hang in,” he loved me and knew that once I found the right therapist and the right treatment program, that his commitment would be rewarded.