WHAT IS EMOTIONALLY UNSTABLE (BORDERLINE) PERSONALITY DISORDER?
Borderline Personality Disorder (BPD) is also known as Emotional Dysregulation Disorder or Emotionally Unstable Personality Disorder (World Health Organization, 1992). Despite being referred to as a ‘personality disorder’, BPD is not a personality defect, but is best understood as a limitation in a person’s capacity to regulate emotions. This means that you can sometimes experience emotions as overwhelming, spiralling out of control, and rapidly changing. These symptoms sometimes go alongside impulsive behaviours and a chronic sense of internal hollowness. I emphasis ‘traits of’ because psychological disorders are nothing but extreme expressions of a continuum of normality. We all have traits and personality tendencies, it only becomes a ‘disorder’ when our way of thinking, feeling and acting severely impair our daily functioning.
The Diagnostic and Statistical Manual of Mental Disorders, D.S.M.5, defines borderline personality disorder as follow:
“A pervasive pattern of instability of interpersonal relationships, self-image, and emotions, and marked impulsivity beginning in early adulthood and present in a variety of contexts, as indicated by five or more of the following:
1. Frantic efforts to avoid real or imagined abandonment
2. A pattern of intense and unstable relationships
3. Persistently unstable self image (and attempts to control it)
4. Impulsivity in at least two areas that are self damaging e.g. spending, substance abuse, sex, reckless driving, binge eating
5. Recurrent suicidal behaviour, gestures, threats or self-mutilating behaviour
6. Affective instability, due to a marked reactivity of mood.
7. Chronic feelings of emptiness
8. Inappropriate, intense anger, or difficulty controlling anger
9. Transient, stress-related paranoid ideation, or severe dissociation
These symptoms may manifest themselves in various ways. For instance, for some people 'frantic effort to avoid feeling abandoned' means not being able to be alone and becoming clingy, whilst for others it is about chronically isolating themselves altogether to avoid disappointment or hurt.
Sometimes people with BPD seem to view the world in a black-or-white, ‘all good or all bad’ fashion. This can be confusing and frustrating to the people around you, but it may be the only way you can safely experience the world at a certain point in time.
Often, the most painful part of having BPD is being misunderstood by and isolated from those close to you. Unfortunately, the BPD traits may eventually push away or sabotage what you actually need and desire most – real closeness and stable relationships. Although it may not seem like that to the outside world, people with BPD are often extremely sensitive and intuitive. If the traits are not well managed, you can appear to be both dependent and hostile, which in most cases makes for turbulent relationships.
Using Google, you will be able to find a lot of information about BPD online. However, not all of them are up-to-date or accurate. It is important to identify trusted, affirmative sources for information.
BPD and perceptive giftedness
Clinicians and psychology researchers have observed that proposed that many individuals have a special talent or gift, namely the potential to be unusually perceptive about the feelings of others.
Under favourable, 'good enough' circumstances, a person who is born with this gift would not grow up to have BPD. However, if the primary caretakers did not have the capacity to be empathically attuned to others, or even resented or was threatened by an unusual perceive child, they may consciously or subconsciously sabotage the child’s healthy development, sense of agency and autonomy. Combined with the child's natural sensitivity and intensity, the psychological wounds he/ she experienced may lead to difficulties in regulating their emotions or forming relationships as adult.
Is it treatable?
The myth that BPD is ‘untreatable’ is an old, inaccurate and very dangerous myth within the mental health industry. While many doctors and mental health clinicians still feel personality disorders as untreatable, most recent evidence suggests otherwise.
Several new forms of treatment for BPD have been developed and found by evidence to be effective. These treatments designed specifically for BPD include Transference focused psychotherapy (Kernberg, 2001), Mentalisation-based therapy (MBT), Dialectical Behavioural Therapy (DBT) (Linehan, 1993), and Schema Therapy. Many of these new therapies for BPD share a theoretically coherent and manualised structure. Most commonly found within the NHS are DBT or MBT-informed models of care-coordinating or therapy.
Another myth is that the treatment for BPD must be long and costly. In fact, contemporary research continuously challenges the old assumption that long-term, intensive treatment is essential for good outcomes; it has been found that therapies with various integrative modalities can have equally positive outcomes.
Because of the limited availability for training opportunities, the place for specialised therapies, such as DBT and MBT, within generic mental health services remains in question. In the real world, only a small percentage of individuals with BPD can have access to specialised treatment. As there is no evidence that any other types of therapy are particularly helpful, the NHS’s advice for the general public is currently to choose psychotherapy based on a combination of personal preference and the availability of treatments in your local area.
effective therapies for BPD
An innovative and integrative approach: Combining cognitive, behavioural and experiential element.
Based on the assumption that many negative cognitions have their roots in past experiences
Therapists take a warm, supportive but active stance.
Not that commonly offered in the NHS
Dialectical Behaviour Therapy (DBT)
By Marshal Linehan in the US (Who recently told the public about her own struggle with BPD!)
Developed to treat chronically suicidal individuals with borderline personality disorder (BPD)
Main goal is to teach the clients skills to cope with stress, regulate emotions and improve relationships with others.
Motivation & Commitment, as well as skills training component are emphasised
Group skills training classes for four types of skills: mindfulness skills, emotion regulation skills, distress tolerance skills, and interpersonal effectiveness skills.
Some NHS Trusts only offer Emotional Regulation group without full treatment
Effective especially with managing suicidal feelings and self harm, but not for everyone.
Mentalisation- based Treatment (MBT)
Commonly offered by the NHS
offered to clients twice per week with sessions alternating between group therapy and individual treatment.
Psychodynamic-based, but more about here-and-now than digging up the past
Therapist takes a ‘curious, active’ stance
Some people’s feedback is that ‘Mentalisation’ as a concept is hard to grasp.
Other treatments offered by the NHS for BPD: Art Therapy, Structured Case Management, STEPP program, CBT.
You can identify with traits of BPD without being officially diagnosed; that does not mean what you experience is any less painful or valid. Recovery from borderline personality disorder can be difficult, but is not impossible.
Treatment for BPD is available and it is effective, but it may take time and effort to find the right therapy or service. Whilst many therapists are knowledgeable about BPD, some are not. Most importantly, your therapist needs to maintain a hopeful outlook in both the prognosis for BPD treatment in general, and in your potential to change. The dogmatic belief that BPD is difficult to treat needs to be challenged, but it should not be your job to prove your therapist wrong.
Borderline personality disorder is not uncommon. In England, it is estimated around one in every 20 people has a personality disorder, and many do seek and are being helped by suitable therapy. If you identify with the diagnosis of borderline personality disorder, seeking help and reaching out can help to overcome feelings of hopelessness and helplessness. There are certain things that you can’t do, but searching for help and support is one thing you can do.