BPD- WHAT IS IT?
BPD stands for Borderline Personality Disorder, a psychiatric diagnosis that describes a cluster of symptoms. People with BPD have difficulty regulating their emotions, may act impulsively, and have intense and unstable relationships with others. Despite the name, BPD does not indicate a personality defect.
Borderline Personality Disorder is a common label attached to emotionally intense people. In recent years, it has also been renamed Emotional Dysregulation Disorder or Emotionally Unstable Personality Disorder.
‘Personality Disorder’ is a confusing and misleading term. Having BPD does NOT mean there is something wrong with your fundamental personality. Instead, it points to certain childhood deprivations and attachment trauma that has limited your ability to regulate strong feelings. You may feel you are constantly dragged down by contradicting feelings and on the verge of collapse.
Alongside emotional dysregulation, you may have a pattern of impulsive and compulsive behaviours.
Many people with BPD also feel empty and numb on the inside.
The truth is, BPD is nothing but an extreme expression of a continuum of normality. We all have traits and personality tendencies, which only become a ‘disorder’ when our way of thinking, feeling and acting are held so rigidly that it severely impairs our daily functioning.
Some of the traits of BPD are:
Fearing abandonment and rejection
Having series of intense and unstable relationships
Not having a strong sense of self-identity, not knowing ‘Who I am’
Impulsive behaviours that are self-damaging e.g. spending, substance abuse, sex, reckless driving, binge eating
Recurrent suicidal thoughts and behaviour
Severe mood swings
Chronic feelings of emptiness
Sudden and uncontrollable rage
Feeling dissociated from reality during times of stress
These symptoms may manifest themselves in various ways. For some people a ‘frantic effort to avoid feeling abandoned’ means not being able to be alone and becoming clingy, constantly checking on their partners, whilst for others it is about chronically isolating themselves 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. One day, your loved one might be the best person in the world, and the next day, you are angry and full of hate towards them.
Often, the most painful part of being labelled as having BPD is being misunderstood by and isolated from those close to you. The sad truth is what y9ou do may push away what you crave the most.
Contrary to common perceptions and what you might read on the internet, people with BPD are not ‘bad people’. They are not manipulative or attention seeking. They are fierce lovers with big hearts; they are born extremely sensitive and intuitive.
BPD- THE TRUTHS BEHIND THE LABEL
“It is increasingly recognised that many individuals who receive the diagnosis of BPD are naturally highly intuitive and perceptive. What was previously thought of as a genetic vulnerability may actually reflect an innate talent. ”
People who were born with intensity have different innate wiring. They are like powerful sports cars.
Just like a powerful car, they have a potent engine. They are an extremely high-performing machine, which requires a special kind of care.
The problem with intense people is that many have not been taught how to run this powerful machine. To borrow a metaphor from Psychologist Dr Edward Hallowell (www.additudemag.com), it is like driving a Ferrari equipped with bicycle brakes.
Most clinicians in conventional psychology and psychiatry have little understanding of emotional intensity, so most intense and sensitive people are diagnosed or misdiagnosed with a myriad of mental disorders. Their innate trait is seen as a disease, and if this idea is reinforced by their family members, they are likely to start believing there is something wrong with them and carry shame all their lives.
“For my whole life I feel different, misunderstood, and rejected. Sometimes I think I am addicted to the feeling of pain because that is the only time I can ‘feel real’.”
THE GIFTS INSIDE BPD
A ‘diagnosis’ in psychiatry is often arbitrary and does not honour our utterly unique make-up as individuals. Due to the lack of education and understanding, ‘neuro-typical’ traits such as high sensitivity and intensity are misunderstood by most clinicians. As a result, many intense people have been wrongly pathologized as having mental illnesses.
People who are labelled BPD are likely endowed with heightened sensitivity and perceptivity. Rather than being born ‘defective’, people usually manifest BPD symptoms as a result of two factors
- Their innate intensity- which also means they need extra love and support to thrive.
- A childhood environment that fails to meet their emotions needs. This can be due to abuse or neglect, but also simply a result of having parents with limited emotional capacity. Even with the best intentions, there might not be a ‘temperamental fit’ between the parents and the intense child, resulting in an emotional gulf.
Research has shown that people with BPD are highly intuitive. They can often sense what others are feeling and thinking. They can even physically feel what others feel. (Park, Imboden, Park, Hulse, and Unger, 1992, p. 227).
In the first study that explicitly investigated this phenomenon, Frank and Hoffman (1986) found that individuals with BPD are more sensitive to nonverbal cues when compared to someone without BPD. Another study later analysed the way people with BPD react to photographs of people’s eyes as compared to observers without BPD. It turns out that the BPD group was more able to correctly guess what emotions these eyes expressed, which showed their enhanced sensitivity to the mental states of others (Fertuck et al., 2012).
People with BPD are able to feel other people’s pain and are sensitive to people’s needs, to the point where it overwhelms them. As compared to someone who is less sensitive and has ‘thicker skin’, they need different skills to manage and understand their emotions. Because of their hypersensitivity, they need to be coached on how to deal with anxiety, how to differentiate between their own emotions and those of others, and how to be assertive in interpersonal situations. Most importantly, they need to be reassured that just because they are different doesn’t mean they are bad. If they have never been taught or modelled how to do this, it is only natural that they become adults who struggle with emotional regulation.
Paradoxically. despite their deep empathy, many people with BPD struggle in navigating social situations. This is especially the case for those who had not been blessed with a healthy attachment pattern as children. As a result, their hypersensitivity may show up as emotional storms and mood swings, be easily triggered by stressful situations, and engender a constant fear of abandonment and rejection (Fertuck et al., 2009).
The dichotomy between their empathy and seemingly lacking-in-empathy when triggered is called ‘Borderline Empathy Paradox’(Franzen et al., 2011; Krohn, 1974).
WHAT CAUSES BPD? IS IT BECAUSE OF MY CHILDHOOD?
It is true that high empathy may be an outcome of growing up in a traumatic and unpredictable childhood environment. Indeed, many people with BPD have a history of childhood abuse, neglect or prolonged separation. As a response to confusing or neglectful parenting, these children had to ‘amp up’ their empathic functioning in order to protect themselves. They were trained by their environment to become highly attuned to the subconscious cues given out by their parents so that they could be prepared for their unpredictable behaviours.
Environmental factors alone, however, do not explain why many siblings who grow up in the same household are not affected in the same way. Thus, we must also consider the biological and innate temperament-based factors that affect people’s distinctive reactions to traumatic events. As psychologist Bockian (2002) suggested: “It is extremely unlikely that someone with a placid, passive, unengaged, aloof temperament would ever develop borderline personality disorder (BPD).”
Child psychologists have found that there is a subset of children who have ‘heightened sensitivity to the social world’, whose developmental and emotional outcomes are critically dependent upon their early childhood conditions. (Boyce, Chesney, Kaiser, Alkon-Leonard and Tschann, 1991)
In most cases, serious difficulties in emotional regulation, or BPD, is a result of two combining factors: A) being born with heightened sensitivity and a gift of perceptivity, and B) a deficient or vicarious childhood environment that fails to meet these children’s emotional needs.
IF IT IS A GIFT, WHY IS IT SO PAINFUL?
Under favourable, ‘good enough‘ circumstances, a child who is born with a gift of perceptivity would not grow up to have serious emotional regulation issues or BPD. However, if the child’s primary caretakers did not have the capacity to attune to their child, or even resented or were threatened by their unusually perceptive child, they may consciously or subconsciously sabotage the child’s healthy development. The nature of psychological abuses may differ, but such abuse always includes an assault on a child’s perceptions and the development of their autonomy.
For gifted children, ongoing negative feedback towards their intuitive perception is ‘particularly damaging’(Park et al., 1992, p.228).
Attachment theories have us know that children will do all they can in order to preserve a good image of their parents. Even when their parents are incompetent, abusive or neglectful, children naturally blame themselves because it is not safe to think of the people they depend on as ‘bad’ (Winnicott, 1960). This scenario is complex if the child is naturally intuitive; many emotionally gifted children have strong feelings of love and responsibility for their parents and often feel compelled by a need or desire to take care of them.
If the parents either explicitly or implicitly reject the child— he or she will internalise the shame of being rejected, and experience him/ herself as being profoundly bad (toxic shame). As a result of their negative experience of themselves and those around them, these children’s natural gifts of perceptivity become ‘hijacked’ by negative bias and negative projections. Without an environment where they can learn to set healthy boundaries and experience secure attachment without exploitation, these children develop ’symptoms’ such as an inability to self- soothe and regulate emotions, a fear of rejection, and a deep sense of internal hollowness.
Many emotionally intense adults have struggled all their lives with feeling lonely, misunderstood, and believing that there is something deeply wrong with them. If you are one of them, I hope that you can reconsider the potential gifts that are within you.
Whilst history cannot be changed, you can rewrite the story that you have been telling yourself. You are in no way ‘bad’. You are not ‘too much’. What you are is a sensitive, intuitive, gifted individual, who was deprived of the right kind of nourishment when you were growing up. Your high level of awareness and acuity to subtleties is not only unusual but also extremely precious.
Because of your innate perceptivity, you cannot ‘un-see’ or ‘un-feel’ things. Perhaps like a poppy that has outgrown his peers, you were shamed and ‘chopped down’. Your struggles are not your fault, and the shame that you carry is a natural reaction to a childhood environment that failed to support you.
Perhaps there is a little voice within you that has always known you were not fundamentally wrong. If you can begin to listen to that voice, you can liberate yourself to retrieve the long-forgotten gifts inside you.
Your psyche wants to heal. Once you can begin to recognise and trust your own fundamental goodness, restoration and integration will naturally happen.
BOUNCING BACK FROM BPD
After being diagnosed/ misdiagnosed with a psychiatric problem, you might be passed from one service to another, from one diagnosis to another. This is not only unhelpful, but can also erode your self-esteem and sense of agency, which is the last thing you need when you are seeking understanding, healing, and ways to fulfil your potential.
Using an internet search engine such as Google, you will be able to find a lot of online information about BPD. However, not all of it is up-to-date and accurate. Thus, it is important to identify trusted, affirmative sources of information.
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 are untreatable, most recent evidence suggests otherwise.
Several new forms of treatment for BPD have been developed and found by evidence-based studies to be effective. 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. Here are some therapeutic models found to be helpful in treating BPD traits:
- An innovative and integrative approach: Combining cognitive, behavioural and experiential elements.
- Based on the assumption that many negative cognitions are rooted in past experiences
- Therapists take a warm, supportive but active stance.
- Not commonly offered through 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)
- The main goal is to teach skills to cope with stress, regulate emotions and improve relationships with others.
- Motivation & Commitment, as well as a skills training component, are emphasised
- Some NHS Trusts only offer Emotional Regulation groups without full treatment
- Effective especially with managing suicidal feelings and self-harm, but not for everyone.
There are four facets to this approach:
Mindfulness is about accepting the present moment. It encourages you to focus your attention on a situation/emotion in a non-judgmental manner. Practice mindfulness by letting experiences and feelings come to your mind and flow out again, or focusing on the physical sensations that come with each emotion and observe your emotions.
Distress tolerance is the ability to observe, experience, and resist negative emotional states. It is the ability to handle stress without indulging in self-destructive behaviours, which are typical of people with Quiet BPD. To practice distress tolerance, you are encouraged to use strategies that involve your senses – run hot or cold water on your hands, suck on strongly flavoured candies, illuminate your room or try aromatherapy, and distract yourself with music. You may need to experiment to find which sensory-based stimulation works best for you.
You will learn to recognize your interpersonal blind spot and start to check your assumptions before jumping to conclusions. You will learn to ask people to clarify their intentions and encourage yourself to consider many different possibilities that might explain the actions of others before you misread their intentions. Developing these skills is essential for remedying the damage caused to your relationships because of BPD.
Emotional regulation (ER) is just a way to make you ‘stop and think’. You can view it as intentional manipulation of your response to an external or internal trigger. A 2017 study on Emotional Regulation Strategies for BPD talks about adaptive ER skills like cognitive reappraisal and problem-solving.
Cognitive reappraisal is a cognitive-linguistic strategy that involves generating alternative interpretations of a stressful, emotional situation. For example, if your driver takes a wrong turn on the road, making you late, try to turn your anger by thinking of the scenery you may enjoy, or accept that it was just a one-off incident.
Problem-solving involves a conscious attempt at generating ideas to fix a stressful situation. For example, you have a dispute with your landlord and are unable to effectively convey a need, and that makes you angry. Instead of thinking of yourself as being submissive or scared, stop, and think. Read up on tenants’ rights and write a letter to your landlord to ask for what you want.
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 (UK) for BPD: Art Therapy, Structured Case Management, STEPP program, CBT.
Borderline personality disorder is not uncommon. You can identify with traits of BPD without being officially diagnosed; that does not mean what you experience is any less painful or valid. 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 traits of borderline personality disorder, seeking help and reaching out can help you 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.
“ Life is hard, and being a survivor of childhood trauma makes you see life differently.
But it’s possible to know what you know, and still find a way to live, and be happy today.”
— Client Kevin. C., London UK