What is BPD?
Borderline personality disorder (BPD) is a serious psychiatric illness. People with BPD have difficulty regulating their emotions and controlling their impulses. Their expression of emotion or impulses are often displayed through intense anger, self injury or suicidal behavior. Although self-injury often occurs without suicidal intent, studies show that a significant number of people with BPD die by suicide (10%). Despite the seriousness of the disorder, recent research indicates that treatment can lead to considerable improvement over time, and there is hope for recovery!
What are the symptoms of BPD?
The fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-V) is currently the most widely adopted system for diagnosing BPD in Canada, although other systems exist.
Borderline personality disorder is listed as a Cluster B personality disorder of which there are 9 symptoms or ‘traits’. In order to be diagnosed, individuals must exhibit at least 5 of the following:
Frantic efforts to avoid real or imagined abandonment.
A pattern of unstable and intense interpersonal relationships characterized by alternating between extremes of idealization and devaluation.
Identity disturbance: unstable self-image or sense of self.
Impulsivity in at least two areas that are potentially self-damaging (e.g., spending, sex, substance abuse, reckless driving, binge eating).
Suicidal behavior, gestures or threats; or self-injurious behavior.
Difficulty regulating mood (e.g., depression, irritability usually lasting a few hours and only rarely more than a few days).
Chronic feelings of emptiness.
Inappropriate, intense anger or difficulty controlling anger.
Paranoid thoughts or a feeling of being disconnected from your body or surroundings.
Citation: American Psychiatric Association (2013). ‘Personality Disorders: Cluster B Personality Disorders - Borderline Personality Disorder’. In Diagnostic and Statistical Manual of Mental Disorders (5th ed.), p.663.
Is BPD treatable?
Yes! There are a number of evidence-based treatment options available for individuals living with BPD to consider exploring. These include:
Dialectical Behavior Therapy (DBT-A, DBT-PE, DBT-SUD)
Mentalization-based treatment (MBT)
Schema-focused therapy (SFT)
Transference-focused psychotherapy (TFP)
Systems training for emotional predictability and problem solving (STEPPS)
Good Psychiatric Management (GPM)
Confronting Common Myths About BPD
BPD is one of the most stigmatized mental health disorders in the modern health system. A number of myths contribute to this designation, including:
MYTH: Borderline personality disorder is a permanent condition that cannot be treated or improve.
FACT: Research shows that people with BPD can go into remission with effective treatment. Recent reports state that up to 88% of people with the disorder experience significant improvement over time.
MYTH: The term “borderline personality disorder” is based on up-to-date research and reflects the true nature of the disorder.
FACT: The term ‘borderline’ was coined in the early 1900s by psychoanalysts as a way to describe clients that strayed from the standard model of neurotic versus psychotic. Such clients were said to be straddling the borderline between the two. Such a system of categorization is no longer in use in contemporary psychiatry and psychology.
MYTH: People with BPD are attention seeking and manipulative.
FACT: The phrases "attention seeking" and "manipulative" implies conscious, deliberate, and malicious intent. People with BPD tend to be impulsive. They are simply reacting to overwhelming emotional pain in an attempt to get needs met.
MYTH: BPD can only be diagnosed in adulthood (18+).
FACT: BPD can be cautiously diagnosed in adolescence (around puberty).
MYTH: People with BPD have a flawed personality.
FACT: BPD is caused by a combination of genetic, environmental, and neurobiological factors, not a personality flaw.
Citation: Alexander, L., Chapman & Kim L. (2007). The Borderline Personality Disorder Survival Guide: Everything you need to know about living with BPD. Oakland, CA: Newbringer Publications Inc.