Managing Borderline Personality Disorder

May is Mental Health Awareness Month and coincidently, Borderline Personality Disorder (BPD) Month. In the mental health care field, borderline personality disorder is something clinicians are exposed to on a fairly regular basis but as a general rule, information about borderline personality is not commonly known.

It’s estimated approximately 2% of the US population suffers from borderline personality disorder and, of that 2%, 75% diagnosed with BPD are women. That percentage means that over four million people have PBD in America alone. The actual prevalence may be even higher due to many people with BPD having been previously misdiagnosed with other disorders like bipolar disorder or major depressive disorder. These other diagnoses are given because they are more well-known and more easily treated with medications than borderline personality disorder.

But what is BPD? In order to better understand BPD, one must first understand the traits of a healthy personality which include: flexibility, dependability, ability for delayed gratification, emotional resilience, self-acceptance, accurate perception of reality and moderation. Personality disorders are abnormal deviations from a healthy personality. The disordered personality can manifest itself through traits like: the inability to be spontaneous in showing true feelings, lacking flexibility, having a sense of guilt and depression after asserting oneself, having the inability to self-nurture or to tolerate and maintain appropriate intimacy and closeness in relationships or to separate from other people.

The American Psychological Association has identified nine symptom categories of BPD. One must show signs of at least five of the nine symptoms to receive the diagnosis. The categories are as follows:

1. Frantic efforts to avoid real or imagined abandonment
2. Pattern of unstable and intense interpersonal relationships characterized by alternating between extremes of idealization and devaluation
3. Identity disturbance: markedly and persistently unstable self-image or sense of self
4. Impulsivity in at least two areas that are potentially self-damaging (e.g. spending, sex, substance abuse, reckless driving, binge eating)
5. Recurrent suicidal behavior, gestures or threats or self-mutilating behavior
6. Affective instability due to marked reactivity of mood (e.g. intense episodic dysphoria, irritability, or anxiety usually lasting a few hours and only rarely more than a few days)
7. Chronic feelings of emptiness
8. Inappropriate, intense anger or difficulty controlling anger
9. Transient, stress-related paranoid ideation or severe dissociative symptoms

How does one develop a BPD? There is no one clear cut cause, but some possible origins of BPD include a history of trauma, cultural expectations, family instability or negative influences during adolescence. Often a history of abuse, neglect, or loss are associated with those that end up with a BPD diagnosis. Most with a BPD diagnosis report difficult or traumatic childhoods. Culture is another possible origin. Certain cultures transmit strong expectations about the way people are supposed to live their lives, and culture influences the way people express emotional distress. Symptoms of BPD occur more often in cultures that emphasize the needs, values and priorities of individuals over those of the community. Also, family instability may contribute to a BPD diagnosis. Today, children are growing up more frequently in single parent families and large extended families are helping less than they were in the past. Lastly, adolescence in general may be a factor. Adolescents are continually surrounded by influences such as gangs, violence, drug use, sensation seeking, eating disorders and risky sexual behavior. It makes you wonder how much of the things we’re exposed to can affect our mental health.

Let’s take a closer look at the characteristics of those with BPD. People diagnosed with BPD tend to have stormy emotional lives and inconsistent or unstable interpersonal relationships. They long for good relationships, but tend to sabotage efforts and are often seen as being manipulative and controlling. They have an intense need to fill the void they feel inside and commonly state they feel empty. They can quickly go from idolizing someone to putting them down. People diagnosed with BPD also often have erratic education and work histories and self-destructive behavior. They tend to have problems with anger, anxiety or depression and they are at a higher risk for suicide.

What does this mean for those of us that interact with those that have a BPD diagnosis? Following are some suggestions for interacting with people who display these traits:

• Do not personalize or argue. Maintain an awareness of personal feelings.
• Be an acute observer. Notice how the person is reacting to you.
• Respect your own needs and rights. Don’t allow yourself to be harassed, berated, or manipulated. Tolerate angry outbursts but set limits to them. (e.g. Say, “If you speak to me this way again, the conversation is over…”)
• Set realistic boundaries.
• Provide clear, easy to understand communication.

Whether we are talking about Borderline Personality Disorder or any other mental health diagnoses there are basic things one can do to maintain optimum mental health:

1. If taking medications, have a mastery of them–understand what they are for, how they can benefit you, what are their side effects, etc.
2. Get therapy or rehab if you feel you need it.
3. Maintain knowledgeable, effective communication.
4. Do regular/purposeful activities.
5. Recognize cues when you are feeling stressed, anxious or depressed and address the stress/anxiety/depression as soon as possible after you notice it.
6. Seek social support–strive to have family love and support and the presence of friends.
7. Take responsibility for managing your overall care.

Tamara Huff, LCPC, is a licensed clinical professional counselor practicing at Brook Lane’s North Village outpatient location. She has over 20 years of experience in the field of mental health. Her areas of interest include personality disorders, conflict resolution, stress management, domestic violence, depression and suicide. Tamara earned her MA in Community Counseling from Andrews University in Michigan.