It is difficult to explain borderline personality disorder adequately in a sentence or two, which means it doesn’t get talked about enough. I am guilty of failing to mention I have BPD, despite being open about having anxiety and depression, because it exposes me to ignorant, incorrect comments — sometimes by people who mean well — and people tend not to listen when I try to explain about BPD. So here is a very basic guide to the facts about borderline personality disorder and some of the most common misconceptions.
What is BPD?
Borderline personality disorder, or BPD, is a mental illness. The NHS website describes it as “a disorder of mood and how a person interacts with others.”
There are a range of symptoms associated with BPD, which are often grouped into 4 main areas:
• Emotional instability
• Disturbed patterns of thinking or perception
• Impulsive behaviour
• Intense but unstable relationships with others
It’s important to remember that everyone with BPD is individual and their symptoms manifest in various ways. Some symptoms seem to be opposites, such as promiscuity and withdrawal from relationships, although they may have similar roots and effects — such as avoiding long-term relationships.. For this reason, stereotypes of people with borderline personality disorder are particularly inaccurate and offensive.
What are the criteria for diagnosing BPD?
There are broad symptoms of which at least 5 must be present over a long period of time and/or have had an impact on your life in order to receive a diagnosis of borderline personality disorder. These include:
• Intense emotions which can change quickly (and often for no apparent reason or reasons which seem trivial)
• Fear of abandonment
• A weak and/or changeable sense of identity
• Impulsive behaviours, such as binge eating, drug taking and mindless overspending
• Suicidal thoughts and/or self-harming
• Difficulty establishing and maintaining stable relationships
• Chronic feelings of emptiness and isolation
• Feeling angry and struggling to control anger
• When very stressed, feeling paranoid, experiencing psychosis and/or feeling dissociated
For a fuller explanation see Mind’s website. Diagnosis can be made only by a mental health professional — in my case, it was a psychiatrist. Diagnosing BPD requires assessment of a complex range of symptoms, so it often takes a long time to be recognised. I was diagnosed when I was 26, for example, despite having displayed the symptoms since my early teens.
Does having BPD mean there’s something wrong with your personality?
No. Borderline personality disorder doesn’t refer to character or traits which we think of as constituting someone’s personality. Neither is BPD a personality type, such as those indicated by the Myers-Briggs test (I’m an INFP on that, in case you were wondering!). The term “personality disorder” refers to a pattern of thinking, feeling and behaviour. The connotations of “personality disorder” are unhelpful when people don’t realise what the term means, but this can be countered with education and information.
Some symptoms of BPD may be thought of as personality traits, such as impulsiveness, but it isn’t necessarily the case that people with BPD are naturally impulsive. You can be impulsive when your BPD symptoms are worse, but the opposite when your symptoms are under control. In this instance, impulsiveness is a behavioural symptom rather than an innate tendency.
Most aspects of people’s character or what we describe as personality are not affected by BPD, though symptoms may overshadow them. Even during my worst episodes of mental illness, my underlying personality remains the same.
Can BPD be treated?
Absolutely. Depending on the symptoms exhibited by an individual, there are a range of treatments which can be helpful in managing borderline personality disorder. These include medication, such as antidepressants, and talking therapies.
Dialectical behaviour therapy is noted for being particularly effective and was developed in order to treat BPD. Personally, I have found drama therapy and counselling very useful. I also use CBT (Cognitive Behavioural Therapy) techniques to cope with some of my symptoms.
There are many self-help strategies which can help. For example, I have found exercise and meditation very useful. I have learnt what works best for me over the years (and continue to learn). Lots of self-care strategies which are used for other mental illnesses are useful for people with BPD, so it’s worth doing some general research around mental health management to find ideas.
As with mental health problems in general, finding treatments which work for you is often a case of trial and error. Different treatments may work better at different times, depending on your symptoms and situation. This means it’s important not to dismiss possible solutions which didn’t work for you in the past.
Busting myths about BPD.
The amount of ignorance and misinformation concerning borderline personality disorder is a constant source of frustration. I have written previously about how annoying I find it when people call it a “terrible label” rather than a mental illness, which perpetuates these myths.
Here are some more common myths:
• People with BPD are manipulative. Some symptoms of BPD may come across as manipulative, but that doesn’t mean they are intentionally manipulative behaviours. Even when someone’s behaviour is intentional, it’s still a symptom and they didn’t ask to have BPD — nobody would — so set boundaries and offer empathy rather than judgment.
• People with BPD are a nightmare to live with. There is a degree of truth in this myth, because anyone can be a nightmare to live with sometimes — but this doesn’t mean all people with BPD are difficult to live with all of the time. Many people with BPD are good partners, parents, children and housemates. Lots of us have qualities which make us delightful to live with most of the time.
All of us have bad days, regardless of whether we have been diagnosed with a mental illness, yet people with BPD get accused of being “nightmares” with more vehemence and less compassion than is shown towards most people. It’s a stigma which doesn’t seem to be shifting as much as the stigma surrounding other mental health issues.
If someone with BPD is exhibiting severe symptoms, they need help and support, not condemnation. Other people’s failure to deal with symptoms effectively can also exacerbate the situation, creating a “nightmare” situation which is not the fault of the person with BPD. It’s especially concerning that this attitude seems to blame people with BPD for their own illness, as if we want to suffer from an often painful and debilitating condition.
• People with BPD are bad people. Not at all: they have a mental illness. Being mentally ill doesn’t make you a bad person (though it may feel like you are during bad episodes, especially when you are exposed to unsympathetic attitudes). This is stating the obvious, yet it’s shocking how many people forget and prefer to characterise people with BPD as merely bad people who are being difficult on purpose. This is never the case.
How you can support someone with BPD.
• Make an effort to understand. Don’t make assumptions about the behaviour of someone with BPD. Read about the condition and the experiences of people with borderline personality disorder. Ignore the damaging comments people without BPD write on social media, which tell you more about their authors’ ignorance and lack of compassion than BPD.
• Listen. Be there for them. Let them express their feelings without cutting them off or making assumptions about how they feel. If it’s hard to listen, remember it’s even harder to experience. If you want clarification, ask questions. Let them know you care — it might be simple, but it means a lot.
• Provide practical help. BPD can be debilitating, especially since anxiety and depression are common co-morbidities. People with BPD might need someone to collect their prescriptions or prepare proper meals. It varies from person to person and between different times. If you are unsure of how to help, just ask at regular intervals and make it clear they are not being a burden.
• Never blame someone with BPD for their own problems. Many symptoms of BPD are self-sabotaging behaviours, but that doesn’t mean they are intentional or that the person exhibiting these behaviours can control them 100%. Pointing out that some problems have been caused or exacerbated by these behaviours is usually unhelpful — people with BPD can recognise their self-sabotage and often beat themselves up about it without external admonition.
I know it’s frustrating to see someone make their situation worse, but blame doesn’t help. If you want to help someone with BPD control their symptoms and take responsibility for their actions, offer emotional support instead.
• Support, don’t push. Everyone learns to manage mental illness at their own pace and different treatments or strategies work for different people, and at different times. If you find out about something which could help someone with BPD, mention it to them and let them know you will help them access the treatment, but don’t pressure them into trying it out.