There are 157 diagnoses in the fifth and latest version of the Diagnostic and Statistical Manual for Mental Disorders (DSM-V). The comprehensive reference book for psychiatric disorders includes disorders like Schizophrenia, Dissociative Identity Disorder, and Bipolar Disorder, all of which are highly distressing mental health disorders to live with.
Every person’s experience with mental illness is unique, and suffering comes in many forms. However, among all the psychological disorders known today, there’s one that is commonly regarded in the psychiatric community as being the most internally painful, filled with intense emotional distress, and mental anguish. It is also one of the most stigmatized: borderline personality disorder.
What is a personality disorder?
A personality disorder is a manner of thinking, feeling, and behaving in a way that is unhealthy, and fundamentally different from what’s regarded as normal by most people. These differences affect every aspect of a person’s life.
There are 10 personality disorders in the DSM-V, which are categorized into three groups: Cluster A, Cluster B, and Cluster C.
Cluster A personality disorders are primarily suspicious.
Cluster B personality disorders are primarily emotional and impulsive.
Cluster C personality disorders are primarily anxious.
Many people feel that the term borderline personality disorder isn’t an accurate representation of the illness. They instead refer to it as emotionally unstable personality disorder (EUPD), which touches on the emotional dysregulation of the illness.
Overview of Borderline Personality Disorder
People with BPD aren’t all exactly the same, but most people experience some degree of these traits during their illness.
Unstable personal identity
BPD is characterized by an unstable sense of self that stems from not feeling as though they have an internal identity. This sets the foundation for many other BPD traits and intrapersonal feelings. It’s common for them to change their style or interests, particularly during adolescence, as an attempt to secure a sense of self.
Intense emotions
This is often further agitated by uncontrollably intense emotional responses, which others frequently regard as unreasonable for the situation. However, for the person with BPD, it’s not just a display. It feels like an incredibly painful, debilitating, and vulnerable experience. It’s often accompanied by feelings of abandonment, betrayal, or both.
Substance abuse, risky behavior, and self-harm
This lack of identity leaves them with constant feelings of painful emptiness that many will try to combat with thrilling and sometimes dangerous experiences. This may include using drugs and alcohol, frequent instances of risky, unprotected sex, compulsive spending, and self-harm as an attempt to self-soothe.
Codependent, rocky relationships
The feelings of emptiness and lack of internal identity often translate as a person who believes only others can determine their value. This maladaptive belief leads to many people getting involved in intense codependent relationships that satisfy a self-fulfilling prophecy of becoming turbulent.
Frantic efforts to avoid real or perceived abandonment
Even though they might see their personal pattern, it seems out of their control. When relationships become difficult, someone with BPD might become more insecure or suspicious, which can put more pressure on a relationship. If their partner pulls away, or they merely perceive their partner is pulling away, it’s often met with an extreme, desperate, and possibly threatening demand for them to stay.
Sometimes others view this as a manipulation tactic or purely for the sake of drama, however, these desperate and inappropriate displays are an uncontrolled, but accurate reflection of how they feel: raw and exposed, with no emotional “skin”, and no control over themselves or their situation.
The pain of this disorder is often so intense and unbearable that up to 10% people who have BPD die by suicide.
Psychotherapy Treatment Options
BPD doesn’t have a cure but you can learn to manage your symptoms effectively, and live a long, fulfilling life. There are several psychotherapy treatment options that can help you get control over your symptoms and reframe your perspective.
These are some options for psychotherapy that are found to be effective for some:
Dialectical Behavioral Therapy (DBT)
Dialectical behavioral therapy was created specifically for people with borderline personality disorder. It’s based on cognitive-behavioral therapy but with a stronger focus on tolerating stress, managing intense emotions and improving relationships. It includes individual therapy and group therapy, and is one of the best treatment options for managing symptoms of BPD.
Schema-focused therapy
You can do schema-focused therapy in a group or individual setting. This type of therapy helps you to identify the systems of thought that lead you to develop these maladaptive ways of having your needs met. It also aims to teach you to develop new ways of thinking and behaving so you can have your needs met in a way that’s healthy for an adult.
Transference-focused therapy (TFP)
Transference-focused therapy is also called psychodynamic psychotherapy. The goal is to help you understand where you have difficulties in interpersonal relationships through the ongoing relationship you have with your therapist. You can explore these difficulties as they come up naturally.
Mentalization-based therapy (MBT)
Mentalization-based therapy helps you to think before you act. It also helps you to identify your thoughts and feelings at any moment, which is a skill that a lot of people with BPD have a hard time with. After identifying your thoughts and feelings, it helps you to imagine a different kind of perspective.
Systems training for emotional predictability and problem-solving (STEPPS)
STEPPS is a structured, 20-week program that involves your family and the people who are close to you. You do group exercises and develop the skills necessary for developing and maintaining positive relationships. It doesn’t only depend on you to change your habits. It’s a team effort you make with your loved ones.
Good psychiatric management
This treatment plan depends on you having a good relationship with your psychiatrist. It depends heavily on managing difficult emotional moments as they come up using an interpersonal perspective to explain why you feel a certain way. It may incorporate different strategies, such as medications, family education, individual therapy, and groups.
Surprising Abilities That Many People With BPD Have
BPD is such a highly stigmatized disorder. There is no shortage of misconceptions of what the illness is and the intentions of the people who have it. Even among the psychiatric community, many therapists turn people away as soon as they hear BPD.
Although BPD can be such a psychologically and emotionally painful disorder to live with, there are some traits that are common among those who have BPD, which appear to be a silver lining.
Here are some of gifts that many people with BPD have:
- People who have borderline personality disorder are extremely resilient. Many people don’t have any idea the kind of strength and perseverance it takes for many people with BPD to get out of bed and go about their day.
The pain they experience can be so debilitating that many can’t go on.
- Many people with BPD have a heightened sense of empathy and compassion for others. They have a special insight into emotional experience, even those that they haven’t been through themselves.
- Those with BPD often have a very curious mind. They’re highly sensitive and feel a strong connection with others.
- With the strength and resilience that goes hand-in-hand with BPD comes courage and bravery. Many people with BPD also feel they have a responsibility to stand up for others.
- They are passionate and emotional (in a good way). While emotions can become overbearing at times, they also serve a very useful and positive purpose. People who feel intense emotions experience the good parts with the bad and are able to share those good things with others.
- Highly intuitive. A person with BPD can often walk into a room and know how a person is feeling. Sometimes they can tell what a person is feeling before they even realize what they’re feeling.
- They love with their whole heart. The reason why they’re so passionate about others is because they care deeply. If they didn’t, their emotions wouldn’t be so intense. If you’re on the receiving end of love from a person with BPD, that can be a very lucky place to be.
Borderline personality disorder is a highly misunderstood disorder in several ways. While it can be exhausting to be around and too intense at times, it’s much more painful for the person experiencing it. A little bit of compassion and empathy can go a long way and for a disorder that ia already so painful, that bit of compassion can make a huge different to another person.
With treatment and self-compassion, BPD is a manageable. You can gain control over your emotions and your life but maintain the insight compassion that you’ve acquired over the years of emotional struggle.