Blog Posts

Hi everyone and welcome back.  Our last blog discussed and outlined Narcissism and Narcissistic Personality Disorder.  This week, we want to outline and discuss another common personality disorder known as Borderline Personality Disorder (BPD).

We have a number of clients who either have been diagnosed with this disorder, or know someone who has.  They often ask questions such as, “why does this happen?” or “How do I deal with a person diagnosed with this?” or “How long does it last and is it treatable?”  Let’s dive in and attempt to answer some of these common questions.

BPD is a complex and often misunderstood mental health condition that affects millions of people worldwide. Despite its prevalence, there are still many misconceptions surrounding BPD, leading to stigma and barriers to effective treatment and support. In this blog post, we’ll delve into the intricacies of BPD, explore its symptoms, causes, and treatment options, and advocate for greater empathy and understanding for those living with this condition.

What is Borderline Personality Disorder? Borderline Personality Disorder is a mental health disorder characterized by pervasive instability in mood, behavior, self-image, and interpersonal relationships. People with BPD often experience intense emotional turmoil, impulsivity, and difficulty regulating their emotions. This instability can lead to tumultuous relationships, impulsive behaviors such as self-harm or substance abuse, and an overall sense of emptiness and identity disturbance.

Symptoms of BPD: The symptoms of BPD can vary widely among individuals but typically include:

1. Intense fear of abandonment and frantic efforts to avoid real or imagined abandonment.
2. Unstable and intense relationships, characterized by idealization and devaluation.
3. Identity disturbance, uncertainty about self-image, goals, and values.
4. Impulsive behaviors such as reckless driving, substance abuse, binge eating, or self-harm.
5. Emotional instability, marked by frequent mood swings, irritability, and intense episodes of anger, anxiety, or depression.
6. Chronic feelings of emptiness and boredom.
7. Difficulty controlling anger, often leading to explosive outbursts or conflicts.
8. Paranoid thoughts or dissociative symptoms during times of stress.

For me as a clinician, when I encounter someone and am looking at a possible diagnosis, there is a common factor.  They view the world in extremes “always”, “never” “love or hate”, etc.  Most of their reactions to life are extreme and “over the top.” 

Causes of Borderline Personality Disorder: The exact cause of BPD remains unknown, but research suggests a combination of genetic, environmental, and neurobiological factors may contribute to its development.  From my experience, traumatic experiences such as childhood abuse, neglect, or prolonged invalidation of emotions are commonly associated with the onset of BPD.  I have rarely seen someone with BPD that does not also have PTSD in some way (usually sexual abuse).  Additionally, abnormalities in brain structure and function, particularly in areas involved in emotional regulation and impulse control, may play a role in the development of the disorder.

Treatment Options:  Treatment for Borderline Personality Disorder typically involves a combination of psychotherapy, medication, and support services. Dialectical Behavior Therapy (DBT) is considered the gold standard in psychotherapy for BPD (however, I would argue that is not always true), focusing on teaching coping skills, emotion regulation techniques, and mindfulness practices to improve overall functioning and quality of life. Other therapeutic approaches such as Cognitive-Behavioral Therapy (CBT), Schema Therapy, Psychodrama, and Neurofeedback may be your best choices.  Personally, I have not seen a lot of positive outcomes with clients who have tried CBT or DBT therapy.  A lot of therapists would become really upset with me and argue that I am wrong.  They may be right and have a strong opinion otherwise.  Yet, I have not personally witnessed much change when using those approaches in 25 years of experience.  Neurofeedback might be the most effective, yet the outcomes are challenging.  

In addition to psychotherapy, medication can help alleviate symptoms of BPD, particularly those related to mood instability, depression, anxiety, and impulsivity. Antidepressants, mood stabilizers, and antipsychotic medications may be prescribed in conjunction with therapy to manage symptoms effectively.

There is a good book out there that I often have people read in attempting to understand and deal with someone with BPD. The book is called, “How to hug a porcupine.”  You may want to read this book as it has some excellent suggestions on dealing with some very difficult people.

I hope this has helped.  Until next time,

Aaron Nicolaides, PhD., LCSW

Therapeuo Health – “Tackling physical and emotional pain.”