Borderline Personality Disorder

TRIGGER WARNING: Mentions of self-harm and suicide.

Like many differences that have been listed in the DSM without objective review for a very long time, Borderline Personality Disorder (BPD) is not what it sounds like. While the name implies that the condition is a flaw in a person’s personality, the disorder is actually a complex response to trauma. 

There is a push to reconsider the name, if only to prevent additional complications caused by negative responses and stigma. It has been demonstrated that self-esteem is often damaged by people being given a diagnosis of “personality disorder”. 

The truth is that it is looking increasingly likely that BPD is actually a form of PTSD.

What is BPD?

Borderline Personality Disorder is a psychiatric condition. It presents as an established pattern of significant relationship problems, an inaccurate (and usually very negative) sense of self, escalated emotional responses (particularly anger), dissociation, fear of abandonment, and a pervasive sense of emptiness or emotional numbeness. 

These factors often culminate in risktaing behaviorus, self-harm, and suicide attempts. Around 3 out of 4 people with BPD attempt suicide. As high as 10% of people diagnosed with BPD die by suicide.

Around 2% of people have BPD.

Causes

Despite having been added to the DSM almost 45 years ago, the why of BPD is still unknown. Theories includes genetics, neurological differences, and psychosocial influences.

Genetic predisposition to BPD has been repeatedly demonstrated. The condition is far more likely to occur in people with a family history of BPD. This is even more so if immediate relatives have BPD.

Negative childhood experiences are a frequent theme amongst people diagnosed with BPD.

Similarly, BPD is commonly accepted as a trauma response. There is some evidence that this trauma can include events that other people would perceive as non-traumatic or commonplace. Whether the situation is objectively traumatic, or perceived as traumatic by the individual, there is almost always an identifiable event that “causes” a person to develop BPD.

BPD is underdiagnosed/misdiagnosed, for a number of reasons including:

• Confusion with mood disorders or other psychiatric conditions
• Being mistaken for side effects of substance abuse
• Stigma associated with the condition; even many medical professionals are hesitant to use the “label”

Clinicians, too, often harbour negative attitudes towards people with BPD, viewing them as manipulative or unwilling to help themselves. Because they can be hard to deal with and may not engage with initial treatment, doctors, nurses and other staff members often react with frustration or contempt.

These attitudes are much less frequently seen from clinicians working with people suffering from complex PTSD or other trauma-spectrum disorders.

SBS Insight. Patrick Walker, https://www.sbs.com.au/news/insight/article/why-we-need-to-rename-borderline-personality-disorder/cv5tjv7gv

Treatment / Recovery

While the use of medication is not in itself a cure for BPD, there are many reports of SSRIs and SNRIs improving mood. Various psychotherapies including Dialetical Behaviour Therapy (DBT) are the most impactful support.

“DBT is the most sought-after, most available and most researched [treatments for BPD]” And it’s been shown to be effective — one study showed that 75% of borderlines treated with DBT improved after a year, and 95% of patients improved after two years.

Most accurate article on BPD we have read—kudos! Melissa Valliant, https://www.borderlinepersonalitydisorder.org/most-accurate-article-on-bpd-we-have-recently-read-kudos

Many people diagnosed with BPD are not told that it can be cured. Or that they could be well enough that they are in remission or no longer meet criteria for diagnosis.

A 2010 study by Mary Zanarini and her colleagues followed approximately 300 former inpatients with BPD for 10 years, interviewing them at two-year intervals to assess the severity of their illness and determine whether or not they had improved. The results: Nearly seven out of every eight patients achieved symptom remission lasting at least four years, and half no longer met the criteria for borderline personality disorder.

Most accurate article on BPD we have read—kudos! Melissa Valliant, https://www.borderlinepersonalitydisorder.org/most-accurate-article-on-bpd-we-have-recently-read-kudos

With the right support, many people with BPD can dramatically reduce the impact of living with this psychiatric condition, if not shake it entirely.