Borderline Personality Disorder (BPD)
Borderline Personality Disorder is a serious condition which is believed to affect between 1-3% of the general population. Yet, despite being so prevalent, BPD is not commonly understood.
People who live in a relationship with a person who suffers from borderline personality disorder often know that something is terribly wrong with the behavior of their family member or loved-one but often do not know what to do about it or that there is even a name for it.
There are a number of different names used around the world for the same disorder:
- Borderline Personality Disorder (BPD)
- Emotional Regulation Disorder (ERD)
- Emotional Dysregulation Disorder
- Emotional Intensity Disorder (EID)
- Emotionally Unstable Personality Disorder (EUPD)
- Emotion-Impulse Regulation Disorder (EIRD)
- Impulsive Personality Disorder (IPD)
The most commonly used name today is Borderline Personality Disorder - or BPD - as defined in the American Psychiatric Association’s Diagnostic & Statistical Manual (DSM-IV-TR).
The term "Borderline" is a historic term coined to describe people who were diagnosed to be on the borderline between a neurotic and psychotic disorder. It is commonly felt that the "Borderline" label is misleading and stigmatizes the disorder. The fifth version of the Diagnostic & Statistical Manual (DSM-V) is scheduled for release in 2010. It is likely that the disorder will be renamed Emotional Regulation Disorder (ERD) or Emotional Dysregulation Disorder (EDD) in the DSM-V.
The following list is a collection of some of the more commonly observed behaviors and traits of those who suffer from BPD /ERD. Click on the links on each one for more information about a particular trait or behavior and some ideas for coping with each.
Alienation - Alienation means interfering or cutting a person off from relationships with others. This can be done by manipulating the attitudes and behaviors of the victim or of the people with whom they come in contact. The victim's relationships with others may be sabotaged through verbal pressure, threats, diversions, distortion campaigns and systems of rewards and punishments.
"Always" & "Never" Statements - "Always" & "Never" Statements are declarations containing the words "always" or "never". They are commonly used but rarely true.
Anger - People who suffer from personality disorders often feel a sense of unresolved anger and a heightened or exaggerated perception that they have been wronged, invalidated, neglected or abused.
Baiting and Picking Fights - Baiting is the practice of generating a provocative action or statement for the purpose of obtaining an angry, aggressive or emotional response from another person.
Blaming - Blaming is the practice of identifying a person or people responsible for creating a problem, rather than identifying ways of dealing with the problem.
Bullying - Bullying is any systematic action of hurting a person from a position of relative physical, social, economic or emotional strength.
Catastrophizing - Catastrophizing is the habit of automatically assuming a "worst case scenario" and inappropriately characterizing minor or moderate problems or issues as catastrophic events.
Chaos Manufacture - Chaos Manufacture is the practice of unnecessarily creating or maintaining an environment of risk, destruction, confusion or mess.
Cheating - Cheating is sharing a romantic or intimate relationship with somebody when you are already committed to a monogamous relationship with someone else.
Circular Conversations - Circular Conversations are arguments which go on almost endlessly, repeating the same patterns with no real resolution.
Cognitive Dissonance - Cognitive Dissonance is a psychological term for the discomfort that most people feel when they encounter information which contradicts their existing set of beliefs or values. People who suffer from personality disorders often experience cognitive dissonance when they are confronted with evidence that their actions have hurt others or have contradicted their stated morals.
"Control-Me" Syndrome - "Control-Me" Syndrome describes a tendency that some people have to foster relationships with people who have a controlling narcissistic, antisocial or "acting-out" nature.
Denial- Denial is believing or imagining that some factual reality, circumstance, feeling or memory does not exist or did not happen.
Dependency - Dependency is an inappropriate and chronic reliance by an adult individual on another individual for their health, subsistence, decision making or personal and emotional well-being.
Depression - When you feel sadder than you think you should, for longer than you think you should - but still can't seem to break out of it - that's depression. People who suffer from personality disorders are often also diagnosed with depression resulting from mistreatment at the hands of others, low self worth and the results of their own poor choices.
Dissociation- Dissociation, or disassociation, is a psychological term used to describe a mental departure from reality.
Divide and Conquer - Divide and Conquer is a method of gaining and advantage over perceived rivals by manipulating them into conflicts with each other.
Domestic Theft -Domestic theft is consuming or taking control of a resource or asset belonging to (or shared with) a family member, partner or spouse without first obtaining their approval.
Emotional Blackmail - Emotional Blackmail describes the use of a system of threats and punishments on a person by someone close to them in an attempt to control their behaviors.
Engulfment - Engulfment is an unhealthy and overwhelming level of attention and dependency on a spouse, partner or family member, which comes from imagining or believing that one exists only within the context of that relationship.
Entitlement - Entitlement or a 'Sense of Entitlement' is an unrealistic, unmerited or inappropriate expectation of favorable living conditions and favorable treatment at the hands of others.
False Accusations - False accusations, distortion campaigns & smear campaigns are patterns of unwarranted or exaggerated criticisms which occur when a personality disordered individual tries to feel better about themselves by putting down someone else - usually a family member, spouse, partner, friend or colleague.
Favoritism - Favoritism is the practice of systematically giving positive, preferential treatment to one child, subordinate or associate among a group of peers.
Fear of Abandonment - Fear of abandonment and irrational jealousy is a phobia, sometimes exhibited by people with personality disorders, that they are in imminent danger of being rejected, discarded or replaced at the whim of a person who is close to them.
Frivolous Litigation and Frivolous Lawsuits - Frivolous Litigation and Frivolous Lawsuits are methods of withholding support, harassing or prolonging conflict by bringing unsubstantiated accusations, meritless appeals or diversionary process into a relationship or a former relationship using the court system as a proxy.
Gaslighting - Gaslighting is the practice of brainwashing or convincing a mentally healthy individual that they are going insane or that their understanding of reality is mistaken or false. The term "Gaslighting" is based on the 1944 MGM movie “Gaslight”.
Harassment - Harassment is any sustained or chronic pattern of unwelcome behavior from one individual to another.
High and Low-Functioning - A High-Functioning Personality-Disordered Individual is one who is able to conceal their dysfunctional behavior in certain public settings and maintain a positive public or professional profile while exposing their negative traits to family members behind closed doors. A Low-Functioning Personality-Disordered Individual is one who is unable to conceal their dysfunctional behavior from public view or maintain a positive public or professional profile.
Hoovers & Hoovering - A Hoover is a metaphor, taken from the popular brand of vacuum cleaners, to describe how an abuse victim, trying to assert their own rights by leaving or limiting contact in a dysfunctional relationship gets "sucked back in" when the perpetrator temporarily exhibits improved or desirable behavior.
Hysteria - Hysteria is inappropriate over-reaction to bad news or disappointments, which diverts attention away from the problem and towards the person who is having the reaction.
Identity Disturbance - Identity disturbance is a psychological term used to describe a distorted or inconsistent self-view.
Impulsiveness and Impulsivity - Impulsiveness - or Impulsivity - is the tendency to act or speak based on current feelings rather than logical reasoning.
Infantilization - Infantilization is the practice of treating a child as if they are much younger than their actual age.
Invalidation - Invalidation is the creation or promotion of an environment which encourages an individual to believe that their thoughts, beliefs, values or physical presence are inferior, flawed, problematic or worthless.
Lack of Object Constancy - A lack of object constancy is a symptom of some personality disorders. Lack of object constancy is the inability to remember that people or objects are consistent, trustworthy and reliable, especially when they are out of your immediate field of vision. Object constancy is a developmental skill which most children do not develop until 2 or 3 years of age.
Learned Helplessness- Learned helplessness is when a person begins to believe that they have no control over a situation, even when they do.
Moments Of Clarity - Moments of Clarity are spontaneous, temporary periods when a person with a personality disorder is able to see beyond their own world view and can, for a brief period, understand, acknowledge, articulate and begin to make amends for their dysfunctional behavior.
Mood Swings - Mood swings are unpredictable, rapid, dramatic emotional cycles which can not be readily explained by changes in external circumstances.
Neglect - Neglect is a passive form of abuse in which the physical or emotional needs of an individual who is incapable of providing for themselves are disregarded or ignored by the person responsible for them.
No-Win Scenarios - No-Win Scenarios and Lose-Lose Scenarios are situations commonly created by people who suffer from personality disorders where they present two bad options to someone close to them and pressure them into choosing between the two. This usually leaves the non-personality-disordered person with a "damned if you do and damned if you don't" feeling.
Panic Attacks - Panic Attacks are short intense episodes of fear or anxiety, often accompanied by physical symptoms, such as shaking, sweats, chills and hyperventilating.
Parentification - Parentification is a form of role reversal, in which a child of a personality-disordered parent is inappropriately given the role of meeting the emotional or physical needs of the parent or of the other children.
Passive-Aggressive Behavior - Passive Aggressive behavior is the expression of negative feelings, resentment, and aggression in an unassertive, passive way (such as through procrastination and stubbornness).
Pathological Lying - Pathological lying is persistent deception to serve one's own interests with little or no regard to the needs and concerns of others. A pathological liar is a person who habitually lies to serve their own needs.
Projection - Projection is the act of attributing one's own feelings or traits onto another person and imagining or believing that the other person has those same feelings or traits.
Proxy Recruitment - Proxy Recruitment is a way of controlling or abusing another person by manipulating other people into unwittingly backing you up, speaking for you or "doing your dirty work" for you.
Push-Pull - Push-Pull is a chronic pattern of sabotaging and re-establishing closeness a relationship without appropriate cause or reason.
Raging, Violence and Impulsive Aggression - Raging, Violence and Impulsive Aggression are explosive verbal, physical or emotional elevations of a dispute. Rages threaten the security or safety of another individual and violate their personal boundaries.
Sabotage - Sabotage is the impulsive disruption of a calm or harmonious status quo in a relationship or domestic situation, occasionally perpetrated by those with Personality Disorders, in order to serve a personal interest, to provoke a conflict or to draw attention to themselves.
Scapegoating - Scapegoating is the practice of singling out one child, employee or member of a group of peers for unmerited negative treatment or blame.
Selective Competence - Selective Competence is the practice of demonstrating different levels of intelligence, resourcefulness, strength or competence depending on the situation or environment.
Selective Memory and Selective Amnesia - Selective Memory and Selective Amnesia is the use of memory, or a lack of memory, which is selective to the point of reinforcing a bias, belief or desired outcome.
Self-Harm - Self Harm, also known as self-mutilation, self-injury or self-abuse is any form of deliberate, premeditated injury inflicted on oneself, common among adolescents and among people who suffer from Borderline Personality Disorder. Most common forms are cutting and poisoning/overdosing.
Self-Loathing - Self-Loathing is an extreme self-hatred of one's own self, actions or one's ethnic or demographic background.
Self-Victimization - Self-Victimization, or "playing the victim" is the act of casting oneself as a victim in order to control others by soliciting a sympathetic response from them or diverting their attention away from abusive behavior.
Shaming - The difference between blaming and shaming is that in blaming someone tells you that you did something bad, in shaming someone tells you that you are something bad.
Situational Ethics - Situational Ethics is a philosophy which promotes the idea that, when dealing with a crisis, the end justifies the means and that a rigid interpretation of rules and laws can be temporarily set aside if a greater good or lesser evil is served by doing so. However, situational ethics can be dangerous when combined with the distorted, crisis-prone thinking of those who suffer from personality disorders.
Splitting - Splitting is the practice of thinking about people and situations as if they were completely "good" or completely "bad" and to occasionally switch between thinking of them as "all good" or "all bad".
Thought Policing - Thought Policing is any process of trying to question, control, or unduly influence another persons thoughts or feelings.
Threats - Threats are written or verbal warnings of intentional, inappropriate, destructive actions or consequences.
Triggering -Triggers are small, insignificant or minor actions, statements or events that produce a dramatic or inappropriate response.
Tunnel Vision - Tunnel Vision is the habit or tendency to only see or focus on a single priority while neglecting or ignoring other important priorities.
An estimated 2% of the US population is estimated to meet the clinical criteria for BPD. However, prevalence results vary widely as shown below. A number of studies have been performed to determine the prevalence of personality disorders and BPD. Prevalence results indicate that BPD affects anywhere between 0.5 and 5.9% of adults
People who have a first-degree relative with BPD are five times more likely to develop BPD themselves. Those who suffer child abuse are also more likely to develop BPD.
Some people who suffer from BPD are prone to suicidal behaviors and self-injury, especially as adolescents. About 8%-10% of diagnosed BPD patients commit suicide.
See Our Statistics section for more statistics on Personality Disorders.
Click here for some statistics on the possible origins of BPD.Borderline Personality Disorder (BPD) is listed in the American Psychiatric Association’s Diagnostic & Statistical Manual (DSM-IV-TR) as an Axis II, Cluster B (dramatic, emotional, or erratic) Disorder:
A pervasive pattern of instability of interpersonal relationships, self-image, and affects, and marked impulsivity beginning by early adulthood and present in a variety of contexts, as indicated by five (or more) of the following:
- Frantic efforts to avoid real or imagined abandonment. [Not including suicidal or self-mutilating behavior covered in Criterion 5]
- A pattern of unstable and intense interpersonal relationships characterized by alternating between extremes of idealization and devaluation.
- Identity disturbance: markedly and persistently unstable self-image or sense of self.
- Impulsivity in at least two areas that are potentially self-damaging (e.g., spending, promiscuous sex, eating disorders, substance abuse, reckless driving, binge eating). [Again, not including suicidal or self-mutilating behavior covered in Criterion 5]
- Recurrent suicidal behavior, gestures, or threats, or self-mutilating behavior.
- Affective instability due to a 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)
- Chronic feelings of emptiness.
- Inappropriate, intense anger or difficulty controlling anger (e.g., frequent displays of temper, constant anger, recurrent physical fights).
- Transient, stress-related paranoid ideation or severe dissociative symptoms.
There is no known cure for BPD / ERD. As a result, families of people who suffer from BPD / ERD are often left to fend for themselves and rely on their own resources.
However, some treatments do exist which have proven effective in managing symptoms. The most common approach is the combination of SSRI medication and DBT Therapy.
Definition:
DBT, or Dialectical Behavioral Therapy, is a psychosocial treatment developed for patients with borderline personality disorder which combines intensive individual and group therapy.
Description:
Dialectical Behavioral Therapy (DBT) was developed for treating Borderline Personality Disorder by Marsha M. Linehan. Some therapists avoid treating patients whom they suspect may suffer from BPD, because of the demands some BPD patients put on the therapist. These demands include multiple phone calls after hours, suicidal ideation and suicidal threats, lack of respect for the therapists boundaries or the boundaries of other patients and staff, aggressive outbursts and stalking.
DBT incorporates an intense program of weekly individual therapy sessions and weekly group therapy sessions.
Individual therapy focuses on addressing a prioritized set of issues starting with self injury, then behaviors which disrupt therapy, then behaviors which disrupt healthy living. Patients are trained in a regime of four skills known as mindfulness, emotion regulation, interpersonal effectiveness and distress tolerance.
Definition:
SSRI's, or Selective Serotonin Reuptake Inhibitor's, are the most commonly prescribed antidepressants for people who suffer from personality disorders. Popular SSRI's include Celexa, Lexapro, Prozac, Paxil, & Zoloft.
Description:
SSRI's relieve symptoms of depression by blocking the re-absorption (re-uptake) of a neurotransmitter in the brain called serotonin. More serotonin in the brain has been shown to improve mood.
SSRI's are generally considered milder than other types of antidepressants. Therefore, SSRI's are typically the first line of approach for practitioners.
Side-effects include: nausea, sexual dysfunction, headache, diarrhea, nervousness, rash, agitation, restlessness, sweating, weight gain, drowsiness and sleeplessness.
The causes for BPD are not precisely known. However, recent research has turned up some clues. Further study is necessary to definitively establish a cause. However, theories do exist.
There is some evidence relating the prevalence of BPD to the kind of environment a child grew up in. A significant percentage of people who suffer from BPD were also abused as children. However, this kind of correlation does not always prove that the environment they grew up in contributed to their own disorder - read our section on the Post Hoc Ergo Propter Hoc Fallacy for a possible explanation why.)
There is a higher incidence of personality disorders in those who have parents who suffer from a personality disorder. This has led some scientists to suspect there may be a genetic link for BPD.
There is also a higher incidence of BPD in females. Read our section on the Amygdala for some information on gender differences in neural activity which may some day lead to a greater understanding of why certain disorders may afflict one gender more than another.
Definition:
Amygdala - The Amygdala is a small region of the brain which plays a key role in emotional regulation, emotional memory and responses to emotional stimuli.
Description:
Recent technological advances have given neurologists two new ways to create 3-D images of the brain. These techniques are known as Positron Emission Tomography (PET Scanning) and functional Magnetic Resonance Imaging (fMRI). By scanning a person's brain while prompting them to think in a certain way, scientists are unlocking clues as to which regions of the brain are responsible for different kinds of thought.
Much of this work has focused on the amygdala - a small region deep in the brain shown below. There is one amygdala the right side of the brain and one on the left as shown below.
The Amygdala's Role in Emotional Reactions
It is believed that the amygdala has an important rule in producing lightning-fast emotional responses to events, whenever a person recognizes an event with a strong emotional element (good or bad) such as events that results in fear, anger or rage or events that result in delight, joy or excitement.
The amygdala is believed to be part of our fast, instinctive and reactive brains. Not much conscious thought is involved if an object is hurled towards us and we instinctively duck. This ability to react instinctively to danger is thought to have historically played a critical function in survival of most species. Similarly, witness the reaction of a crowd whenever a sports team scores a goal. There is a universal instant response of throwing hands in the air, widening the eyes, leaping into the air etc, without much thought given. When you see these instinctive reactions occur, the amygdala is at work.
The Amygdala and Memory
The amygdala has also been shown to have an important function in enhancing memory functions by releasing stress hormones, such as adrenaline. It has been shown experimentally that rats, who have had their amygdala disabled lose their fear of cats. It has also been shown that increasing stress hormones improves memory of an event. This helps explain why people can remember stressful moments in great detail - such as times of disasters or crises, when adrenaline is released and yet can easily forget long periods when nothing significant seems to have happened.
Gender Differences in the Way the Amygdala is Connected
Another interesting finding resulted from a study comparing amygdala activity in males and females. When shown images containing strong emotionally arousing content, it was found that the amygdala on the right side of the brain was the most active in men, while the amygdala on the left side of the brain was most active in women.
Other experiments with people who are relaxing have shown that in men, the right amygdala is more closely connected to the rest of the brain than the left, while women show a stronger connectivity between the left amygdala and the rest of the brain. Additionally, in men the right amygdala seems to be strongly connected to regions of the brain normally associated with interactions with the external environment while in women, the left amygdala seems to be strongly connected to regions of the brain normally associated with more internal thought. This suggests that in an emotional context, men are biased toward thoughts about the external environment and women toward thoughts about the internal environment.
The Link between the Amygdala and Emotional Regulation Disorder / Borderline Personality Disorder
In a famous experiment at Yale University, 15 people diagnosed with BPD and 15 people with no BPD diagnosis were shown photographs of faces with neutral, happy, sad, and fearful facial expressions while mapping the activity in the brain using fMRI. It was found that there is a lot more activity in the left amygdala of people who had been diagnosed with Emotional Regulation Disorder /Borderline Personality Disorder when exposed to an emotional stimulus than there is for most other people.
Source: Donegan et al, Amygdala hyperreactivity in borderline personality disorder: implications for emotional dysregulation.
Borderline Personality Disorder (BPD) and Bipolar Disorder are similar in that both are characterized by dramatic changes in mood. It is thought that many people who suffer from BPD are inaccurately diagnosed as having Bipolar disorder because it generally carries less stigma and is easier to treat with pharmaceuticals. However, there are also some important differences between Bipolar & BPD:
Frequency of Mood Cycles
Mood swings for people who suffer from Borderline Personality Disorder typically cycle much faster than for people who suffer from Bipolar Disorder. BPD sufferers often exhibit mood cycles lasting from a few hours to a few days. People who suffer from Bipolar Disorder typically exhibit mood swings lasting from a few weeks to a few months.
It should be noted that some Bipolar patients are characterized or diagnosed with Rapid Cycling Bipolar Disorder which has the same symptoms as Bipolar Disorder but with a shorter cycle time.
Relationship Basis
People who suffer from BPD often exhibit an acute Fear of Abandonment. The mood swings a person with BPD exhibits are often attached to their fear of being left alone or their preoccupation with not being alone. Sometimes, BPD is described as a "relationship disorder" in that it manifests itself in interactions with others.
Bipolar Disorder tends to be less relationship-based. People who suffer from Bipolar Disorder often display cycles of mood which are more inwardly self-focused and have less to do with how they feel about the relationships they are involved in.
Dissociation
Borderline Personality Disorder comprises both psychotic & neurotic thought processes. This gives rise to the name "Borderline" because it is thought to be on the "borderline" between psychosis & neurosis. The thinking and behavior of a person with Borderline Personality Disorder includes more mental departures from reality, known as Dissociation or "feelings create facts".
In contrast, Bipolar Disorder tends to be more neurotic in that the mood swings tend to be based more on extreme exaggerations of fact.
Response To Treatment
People who suffer from Bipolar Disorder often respond positively to appropriate regimes of medication.
People who suffer from Borderline Personality Disorder may also exhibit some improvement when treated with appropriate medication but typically also require extensive therapeutic intervention such as DBT over a period of months or years in order to see comparable results.
Both groups are often reluctant to seek help and may be resistant to medication. Also, both groups have a tendency to stop taking prescribed medications when they begin to feel better which often leads to relapses.
Movies Portraying Borderline Personality Disorder Traits
A Streetcar Named Desire - A Streetcar Named Desire is a is a 1947 play written by Tennessee Williams, later adapted for film, which tells the story of a woman who displays histrionic and borderline traits, who goes to live with her codependent sister and her narcissistic husband.
Fatal Attraction - Fatal Attraction is a 1987 Movie Thriller starring Glenn Close & Michael Douglas about Dan Gallagher, a New York Lawyer (played by Michael Douglas) who is stalked by Alex Forrest (played by Glenn Close) with whom he has had an affair. The story portrays Alex's increasingly unstable behavior as a result of having Borderline Personality Disorder and feeling abandoned by Dan.
Girl, Interrupted - Girl, Interrupted is a 1999 Columbia Pictures movie which chronicles the experiences of a teenage girl with Borderline Personality Disorder, who is admitted to a mental health institution after attempting suicide.
Mommie Dearest - Mommie Dearest is a 1981 biography of Hollywood Actress Joan Crawford, played by Faye Dunaway, who, according to the account in the movie, exhibited Obsessive Compulsive, Borderline and Narcissistic Traits.
Single White Female - Single White Female is a 1992 Columbia Pictures Release starring Bridget Fonda and Jennifer Jason Leigh which portrays the events after a young woman takes in a roommate who exhibits some of the symptoms of Borderline Personality Disorder (BPD) and Dependent Personality Disorder (DPD) including mirroring, impulsivity and fear of abandonment.
The Wizard of Oz - The Wizard of Oz is a 1944 movie starring Judy Garland which is sometimes used as a metaphor to describe the disconnect between the dissociated reality of the personality-disordered individual (Oz) and the real world experienced by the Non-PD (Kansas). The metaphor is based on the iconic phrase: "Toto - I've a feeling we're not in Kansas any more".
Out of the FOG Support Forum - Visit the support forum here at Out of the FOG.
Psychforums BPD forum - Psychforums Site.
BPD Recovery - http://www.bpdrecovery.com/ BPDRecovery is a site that focuses on recovering from Borderline Personality Disorder. The Site is run by a recovered Borderline. It is a non-discriminatory website which means that all individuals are welcome - whether you've been formally diagnosed or simply recognize yourself or someone you know in the diagnostic criteria, you are welcome here!
Anything to Stop The Pain - information site, blog and support board for Non-Borderlines, with a particular emphasis on supporting people who have children with BPD and people in a committed relationship with a person who suffers from BPD.
http://bpdcentral.com/support/email.shtml The Welcome to Oz Online Community for Family Members with a Borderline Loved One.
http://borderlinepersonality.ca/board BPD Support Site run by BPD Author A. J. Mahari.
http://www.BPDCentral.com - An information and support site about BPD run by Randi Kreger, co-author of "Stop Walking on Eggshells".
http://www.BPDFamily.com - Support Site for the family and relationship partners of individuals with BPD.
http://outofthefog.net/Disorders/BPD.html
http://outofthefog.net/Disorders/BPD.html
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