A Bit of History…
Borderline Personality Disorder, or BPD, symptoms first came on the radar as an actual disorder in the late 1930’s. At first, doctors saw the symptoms as bordering on, or overlapping, with schizophrenia, non-schizophrenic psychoses, and neuroses disorders. Because of this, for a long time, BPD became a catchall diagnosis when it seemed unclear where else the patient could fit. It was due to this blanket effect, and the multiple disorders floating around inside the disorder, that not only were doctors hesitant to diagnose patients with BPD, but when they did the patient had little hope for an effective treatment, sometimes even pharmaceutical treatment being unable to help.
From the late 1930’s up until the mid-1970’s the disorder and its criteria evolved from being a mess of several psychoses and neuroses in the “border line group”, to a firm, well-researched clinical diagnosis. Finally, in 1980 Borderline Personality Disorder was added to the DSM-III, and became an official psychiatric diagnosis.
Thirteen years later, after its first appearance in the DSM, Marsha Linehan, a psychologist, developed Dialectical Behaviour Therapy, or DBT. It was sort of a build on, or extension to Cognitive Behaviour Therapy, or CBT. At this time, DBT is the most effective treatment to date for those suffering with BPD. Further details of DBT will be covered in the next post.
What is BPD?
History aside, BPD is a serious mental disorder. It is often misdiagnosed since its characteristics often overlap or mimic symptoms of several other disorders. Bipolar Disorder tends to be a common misdiagnosis for those who are actually suffering from Borderline Personality Disorder.
The characteristics of BPD typically present in adolescence, or in young adults, and they can vary greatly in severity and intensity from person to person. Its roots lie in the person’s childhood where the seeds of abandonment are sown, and neglectful, absent, or invalidating parents foster an environment where the child is not given time and attention, nor are they given the tools, guidance, or support to help them learn how to understand, tolerate, and regulate their emotions.
From this disability a child growing into adolescence and young adulthood will turn to reckless and impulsive behaviours, substance abuse, as well as several other disorders or addictions in order to cope. They will be subject to unstable moods, skewed perceptions of reality, and unstable relationships, with others as well as with themselves. Many borderliners suffer identity issues and periodically may completely dissociate from reality causing severe disruption in their day-to-day life.
This can cause quite a paradox because to the outside world everything will seem okay but in the mind and private life of a borderliner things are chaotic, confusing, frustrating, disregulated, and extremely stressed.
The Abandonment Issue and Ineffective Relationships
One of the most prominent features of the disorder is the abandonment issue. Typically, a person suffering with BPD will first experience this in their childhood, sometimes as early as infancy, or even as late as adolescence, when one or both of their parents are absent, and/or neglectful. This is particularly felt when the child is suffering in moments of high stress or emotion, and the parent or parents may invalidate the child and their emotions by dismissing them and how they feel, ignoring them, or even to the point of mocking them for having or showing emotion, or telling them what they are feeling is incorrect or unjustified. This lack of support and guidance shows the child real as well as perceived abandonment.
As the child grows into adolescence they often face great confusion, frustration, and isolation surrounding their thoughts and emotions. Often feeling as though something is wrong with them, and that they are unlovable. Their inability to regulate, or even understand their emotions leads them to find other ways to try and cope. They will suffer wild mood swings in a matter of hours, and sometimes lasting as long as several days. Family and friends come to see and identify them as erratic and “too sensitive”. This is also the leading cause of a person suffering with BPD to be misdiagnosed with Bipolar Disorder.
Feeing abandoned and being subject to unstable moods or feelings typically lead to extremely unstable, and often disproportionate relationships for the budding borderliner. It’s in the relationships that the skewed perception of reality and confusing emotions is most prevalent, and one of the few ways the symptoms of BPD can actually be seen, although it may not be understood as such.
Borderliners suffer greatly in relationships as they are in constant fear of losing the other person, that they are not as important to the other as they are to the borderliner, or they fear they are not as liked or loved as they need to be. The borderliner may feel that they care more about the person than the person cares for them. This can lead to overt or extreme gestures by the borderliner to try and “keep” the other person in their life, sometimes to the point that the borderliner will threaten or attempt suicide if the other person leaves. It is unfortunately due to these overt gestures and extreme threats that may end up causing the end of the relationship as the other person leaves out of discomfort, unease, and, in extreme cases, fear. This self-fulfilling prophecy is often lost on the borderliner as they see this upheaval as further proof that they are forever destined to be abandoned.
The flip side to this idolatry the borderliner exhibits with their relationships is that when they are left or let down by the other person, whether by not reciprocating their gestures, or by leaving them, the borderliner often turns to vilification. The borderliner will knock the other person off their imposed pedestal so fast it will be in question if the borderliner ever liked the person in the first place. This typically is used as defense mechanism by the borderliner to somehow placate themselves in the midst of this great upheaval, even if it was their gestures that caused the person to end the relationship. The borderliner is so unable to regulate their emotions and their distress that it unfortunately doesn’t take much on the part of the other person for them to turn to vilification. It can be as simple as an unreturned text or phone call, a misunderstood comment, gesture, or glance, and sometimes even a threat that is only perceived as such by the borderliner.
These symptoms can be debilitating for the borderliner leading to isolation and reckless, impulsive behaviours. Many borderlners often struggle with other disorders or addictions in addition to struggling with BPD, in an effort to quiet their mind and emotions, to the point of total avoidance altogether. They turn to substance abuse, reckless driving or other reckless behavior, impulsive spending beyond their means, promiscuity, eating disorders, self-harm, suicide ideation, and suicide attempts. A borderliner will go to great lengths at times to completely numb themselves from the torture of thinking or feeling anything.
Suicide Ideation, Attempts, and Hospitalization
Sadly, it is because these symptoms are so pervasive that borderliners often think, dream, and fantasize of suicide. It often feels like it is the only way out. Throughout the life of a borderliner, starting as young as in adolescence, they will most likely be several suicide attempts and/or hospitalizations. Hospitalization for the borderliner can be a double-edged sword though because initially they will take comfort and solace in the structure and support of the hospital’s psychiatric services, doctors, and nurses. However, as most hospital stays are very short-term, and are not indefinite, the borderliner, especially without proper diagnosis, will not receive proper treatment or support for their unregulated emotions and skewed thinking, and will eventually come to hate the structure and support they craved at the beginning. This is also exacerbated by the inability to turn to their destructive behaviours and outlets, like substance abuse or self-harm, in order to relieve their distress.
What Causes BPD?
Unfortunately, BPD is still in its infancy as a psychiatric disorder, and so research and data is still being discovered and developed. It is unclear what exactly causes BPD. Among professionals the causes are attributed to genetics, biology, and environmental factors. This has yet to be definitively proven but remains the most common understanding of what causes BPD, until more research and data becomes available.
At this time, Canada does not have any accurate rates for our population in how many may be suffering with BPD. However U.S. surveys show that 1 in 100 suffer from BPD, or approximately 6% of their population. Since the symptoms of Borderline Personality Disorder overlap or mimic that of several other disorders, such as Bipolar Disorder, or they are masked by the destructive behaviours, or “secondary” disorders, such as substance abuse, promiscuity, and eating disorders, it is most likely that this number is probably even higher than what is currently known as they have yet to be properly diagnosed.
Hopefully as time goes on, and further research is done, those suffering with BPD will finally be properly diagnosed, and will be able to get effective treatment sooner rather than later, or too late. I also hope that BPD will gain more in understanding and acceptance from society and a number of professionals as well, as there are a number of doctors that will actually refuse to treat someone diagnosed with BPD due to their unstable moods, and demands made of their relationship with their doctor.
It is a fierce battle in the mind of a borderliner, diagnosed or not. I hope for anyone suffering with BPD that one day you will receive proper, effective treatment, and be relieved of the paralyzing symptoms. I wish for you all that you find a life worth living, with happy, stable relationships, regulated and controlled emotions, without the use of destructive habits and addictions, and a peace within that sustains you.
I wish this for myself someday too.
Bye for now 🙂