I was diagnosed with Borderline Personality Disorder (BPD) on 12 May 2021, after suffering from symptoms such as severe anger and violent outbursts for many years prior. I knew I had to seek help around this time, as my outbursts and emotional instability was destroying my relationships and mentally, I was completely worn down.
The worst thing for me about receiving my BPD diagnosis was the stigma surrounding the disorder itself. I remember crying to my boyfriend after researching it, as many blogs and forums would describe BPD patients as “crazy,” “unlovable” and “too much to deal with”. This broke me. I always felt as though I was too much for people, that I was overbearing and aggressive, which made me push away the ones who loved me most.
Looking back, I wish I knew everything about my disorder that I know now as it would have avoided the emotional torment I put myself through. Stigma surrounding personality disorders are particularly dangerous to those suffering from them. It can severely damage our self-perception and push us towards destructive behaviour or lead us into periods of depression, as we can internalise all these negative and inaccurate things we read about our disorders (known as self-stigma).
BPD is a cluster B personality disorder that is characterised by difficulty to regulate your emotions, meaning that those who have the disorder have extended periods of intense emotion and struggle to return to a stable state after a particularly emotionally triggering event. BPD also causes a wavering sense of self; meaning that your self-image, likes and dislikes, goals etc. may change frequently based on emotional experiences or even by indirect influence of those close to you. Studies show that BPD affects around 1 in 100 people, which to put into perspective, 1% of the UK population (at the time of writing) is 687,348.
There are many reasons a person could develop BPD. Inherited genes can make a person more susceptible to developing BPD, as studies found that if one identical twin has BPD there is a 2 in 3 chance that the other twin would also have the disorder. However, there is no evidence to suggest the existence of a gene for BPD.
MRI studies of the brain of BPD patients also suggest that the disorder can develop due to issues with brain development. The scans showed that in many people with BPD, the amygalda – which contributes to the role of emotional regulation, especially negative emotions like fear and anxiety; the hippocampus – which helps in regulating behaviour and self control; and the orbitofrontal cortex of the brain – which has involvement in planning and decision making – (with all three contributing to mood regulation) were smaller than anticipated or had unusual levels of activity. Problems with these three areas of the brain may well contribute to BPD symptoms, as the inability or struggle to regulate these factors are a large part of what BPD is.
The most common cause of BPD is through suffering a great trauma, especially from a young age as this trauma affects the early development of your brain. This can include being a victim of any form of abuse or neglect; being subjected to long-term fear and stress; and growing up with another family member who suffered from another mental health condition. For me, the ‘trauma’ that caused my BPD was severe bullying for over several years, which caused me immense stress; crippled my self esteem; and changed me from a happy, outgoing child to an anxious, depressed, social recluse. However, being diagnosed with BPD was a turning point for me as I was able to finally process this trauma and begin to heal.
In order to receive a diagnosis of BPD, you have to present five or more of the following diagnostic criteria (taken from Very Well Mind):
- Chronic feelings of emptiness
- Emotional instability in reaction to day-to-day events (e.g., intense episodic sadness, irritability, or anxiety usually lasting a few hours and only rarely more than a few days)
- Frantic efforts to avoid real or imagined abandonment
- Identity disturbance with markedly or persistently unstable self-image or sense of self
- Impulsive behaviour in at least two areas that are potentially self-damaging (e.g., spending, sex, substance abuse, reckless driving, binge eating)
- Inappropriate, intense anger or difficulty controlling anger (e.g., frequent displays of temper, constant anger, recurrent physical fights)
- Pattern of unstable and intense interpersonal relationships characterized by extremes between idealization and devaluation (also known as “splitting”)
- Recurrent suicidal behaviour, gestures, or threats, or self-harming behaviour
- Transient, stress-related paranoid ideation or severe dissociative symptoms.
If you feel you relate to five or more of these criteria, I strongly advise you seek support from a GP or mental health professional.
A big issue with BPD is that it is often confused with Bipolar Disorder (BP), which stigmatises the disorder even more. Although they share similar characteristics, the two are very different. BP also effects a person’s mood, however, it does not cause a difficulty to regulate all emotion like BPD, but rather your moods swing from one extreme to the other, causing periods of mania or depression.
Although people with BPD also suffer from these periods, they are typically triggered by something (usually in relation to their relationships). In both BPD and BP, these periods can last for weeks or even months at a time – but with BPD a person can go from manic to depressed sometimes several times per day if they are triggered.
A period of mania (referred to as being ‘manic’) is when a person feels very high or energetic. They often feel on top of the world, can think they’re ‘cured,’ or feel like they no longer need their medication, which has a significant negative impact on their mental wellbeing. Key signs that a person is in a manic period are:
- Having lots of energy
- Having ambitious plans or ideas
- Overspending on items you wouldn’t normally want/need, or overspending in general (which worst case puts them into financial distress)
- Feeling very happy
Other signs of a manic period include;
- Getting irritated/annoyed easily
- Talking quickly
- Not wanting to or actually not eating or sleeping
They may also suffer symptoms of psychosis, which is when they see or hear things that are not really there.
A period of depression, on the other hand, is exactly what it sounds like. People suffering from BP may be initially misdiagnosed with clinical depression if they have never had a manic period prior to seeking a diagnosis. This is not a common misdiagnosis with BPD, as people with BPD display other symptoms which differentiate between the disorder and clinical depression. Key signs that a person is in a depressive period are;
- Overwhelming feelings of worthlessness
- Lack of motivation
- Not eating or washing
- Suicidal ideation or intent
(If you suffer from these symptoms you can anonymously and confidentially contact Samaritans 24/7 via freephone 116 123 or texting SHOUT to 85258)
A prime example of the confusion between BPD and BP is that people assume Kanye West has a BPD diagnosis, despite Kanye himself speaking out on his BP diagnosis to Donald Trump in 2018. The main cause of this confusion falls to the fact that news outlets repeatedly confuse the two abbreviations or use them interchangeably. When you Google BPD symptoms thinking you are reading about Bipolar Disorder you are actually causing yourself to be misinformed. For example, people with BPD experience a fear of abandonment; a lack of confidence; and a history of unstable personal relationships, which are symptoms not commonly associated with BP.
This confusion has been damaging to those diagnosed with BPD, as often people see West’s outbursts on social media; his endless tirades against his ex-wife Kim Kardashian and her ex-boyfriend Pete Davidson (who ironically has a BPD diagnosis); or read about his anti-Semitic comments and assume that his supposed BPD is to blame.
News outlets such as NBC, Men’s Health and Queen’s Journal are among many who have used BPD when referring to BP, or have outright said that West suffers from borderline personality disorder and have since amended the online versions of their articles to correct this mistake. But it’s too late, the damage has already been done.
A key symptom of BPD is unstable relationships, that swing between extreme closeness and intense dislike which can seemingly change out of nowhere. You may feel as though other people abandon you when you most need them, or that they are smothering you and it can be overwhelming. Mainly, people with BPD fear abandonment and are hypersensitive to rejection which can cause them to lash out in anger and can act out impulsively by constantly texting or phoning the person; calling that person at inappropriate and unsociable times; or even making threats of self-harm or suicide if that person were to leave you. This fear of rejection can also cause you to experience extreme paranoia; anxiety or sorrow. You can also suddenly get irritated/angry at someone or every little thing they do which can cause a sudden intense hatred for a person you would have idolised days prior.
For someone with BPD, we view relationships as black/white, meaning that they are all perfect and that person is the best thing to happen to you, or the relationship is destined to fail and everything about that person is awful. It is hard for us to see any common ground or grey area in their personal relationships. We bounce between a ‘leave me alone/please don’t leave me’ state of mind, which can be confusing for any relationships they have and sadly lead to break-ups or a loss of friendship.
A factor of unstable relationships is the development of a ‘favourite person,’ which for someone with the disorder is not simply a person they like the most but rather the person they deem most important in their lives. These FP’s can be anyone, but typically is a family member, a romantic partner or a close friend. FP’s develop due to the severe fears of abandonment that come with BPD, so those with the disorder would attach to this person and become reliant on them for support, security, and emotional validation.
However, FP’s can contribute to a wavering sense of self and many people with BPD have admitted to unknowingly altering their personality and appearance to match that of their favourite person – so if they lose their FP they can fall into a depressive period as they entirely lose sense of who they really are. I have significant experience of this, as my favourite person changed, I completely altered my personality and appearance to match theirs which is clear to see based on my ever-changing appearance over the years.
But that is not to say that the existence of an FP is a bad thing. Through discussion with my doctor, we came to the conclusion that my current FP is my boyfriend of 4 years but it seems that I haven’t ‘absorbed’ his personality or appearance, but rather the stability of a long-term relationship has enabled me to be more comfortable in my own identity. Although I still have a wavering sense of self, my personality at its core has not changed in the time that I’ve been with my boyfriend. I cannot say that everyone can have the same experience with FP’s, but this is what it has been like for me.
Another common misconception of BPD is that those with the disorder cannot have fulfilling relationships, but this is absolutely not the case. Despite the fact that a key symptom of BPD is unstable relationships, through Cognitive Behavioural Therapy (CBT) or other forms of treatment you can learn to understand that not all relationships are black and white which enables you to go on and form close bonds with people in a platonic or romantic way that can last for a long time.
It is misconceptions such as this which add to the stigma surrounding the disorder, so I want to ‘debunk’ other common misconceptions that are held about BPD.
Misconception 1: BPD cannot be treated
This is a particularly dangerous misconception, as the belief you cannot be treated stops so many for reaching out to mental health services for help. This was the case for me, as prior to my diagnosis I thought I was just ‘broken’ and could not be helped. The fact is, BPD is a complex disorder which requires two key features to ensure successful treatment. The first is to start treatment early, as waiting for too long causes negative coping mechanisms to become ingrained and much harder to diminish. Therefore, treatment which starts early and continues for a prolonged period increases the chances of recovery.
The second is engaging in evidenced based treatments such as CBT or Dialectical Behaviour Therapy (DBT), combined with mood stabilisers or anti-depressants have proven to be the most suitable and successful treatment for BPD. Although you will never be fully cured, you can reach the point where your symptoms no longer fit the criteria to maintain a BPD diagnosis. But it should be noted that you can go between qualifying and unqualifying at different points in your life, depending on whether you consistently engage with treatment.
Misconception 2: People with BPD are not capable of love
This is a cynical generalisation of BPD, and it wildly incorrect. People with BPD can love and be loved just like ‘normal people’ can, and many with the disorder go on to have happy, long-term committed relationships. In my experience, people with BPD are the most loving people, as we love with our whole heart and will do anything to support the ones we love and show them we care. Although, this can be negative as we become so attached that the slightest notion of rejection or abandonment causes our mood to instantly shift and we can regrettably lash out in anger or push out loved ones away in fear.
If you love someone with BPD, you need to truly understand how our ‘brain works’ (i.e. how we think, how the smallest things can trigger a mood switch/splitting etc.) and to be patient and supportive in any way you can. It is not your job to ‘fix’ them, you just need to be a good support system for them to see them through treatment and beyond.
Misconception 3: People with BPD do not really want to kill themselves, so threats of suicide should not be taken seriously
People often view threats of suicide from those with BPD as a dramatic overreaction to a minor inconvenience or as a means to get a reaction or attention, which is an extremely unfair and incorrect assumption. The fact is that BPD has a higher suicide rate than any other psychiatric disorder and the general population, as research has shown that approximately 70% of people with BPD will attempt suicide at least once in their lives and sadly about 10% die by suicide.
“People with BPD are in constant emotional pain, pain so severe that it is often unbearable. Suicide attempts are often maladaptive efforts to make the pain stop and are not wishes to die.” – TARA4BPD
The risk of not taking a threat of suicide seriously is far too high. Some signs to look out for include:
- Threatening to or talking about wanting to hurt or kill themselves
- Seeking access to means to kill themselves such as medication, sharp objects, or other means
- Acting or engaging in reckless activities, seemingly without thinking
- Withdrawing from friends and family
- Experiencing dramatic mood shifts/splitting
- Increased substance abuse
Misconception 4: People with BPD do not feel empathy
People with BPD are likely to struggle with cognitive empathy – which is how well an individual can perceive and understand the emotions of others – and often can’t pick up on context clues to understand how another person may feel. When experiencing intense emotion, our minds often have difficulty processing the appropriate information to understand how a person feels, and altering their behaviours to best accommodate that person.
However, we have better-than-average affective empathy meaning we vicariously experience the emotions of others. If someone we are with is experiencing strong emotions, we are likely to feel that emotion and become overwhelmed by it.
We also must remember that not all people with BPD experience empathy in the same way. For example, I have some issues with cognitive empathy in that I pick up context clues that are not correct representations of how a person feels (i.e. if someone is quiet around me, I assume they are angry at me). I still have the ability to pick up on context clues, but I struggle to attribute them to the correct emotions.
Alongside this, I have a strong sense of compassionate empathy – which motivates people to go out of their way to relieve the mental, physical, or emotional pain of others. If I feel there is something wrong, I do everything I can to fix the problem of others, sometimes at great emotional or physical strain to myself. This is a very common trait of people with BPD.
Misconception 5: People with BPD are dangerous and abusive
Research shows that people with BPD are more likely to commit intimate partner violence (IPV) compared to the rest of the general public. This is mainly caused by difficulty regulating and controlling emotions, therefore intense anger or other negative emotions can cause them to physically lash out.
But, the majority of people with BPD do not commit IPV.
In fact, they are more likely to harm themselves than to harm others.
The fact is that on average, people with BPD are more likely to be victims and/or survivors of IPV, and can even have their symptoms used against them by their abusers to ‘justify’ their abusive acts. This in turn causes them to develop new BPD symptoms, or have an increase in current symptoms.
BPD is a very complex and confusing disorder. It was hard for me to wrap my head around at first, but through research and treatment I am finally able to understand myself and my disorder. I hope I also have been able to help you understand what BPD is and what it is really like.
Featured Image Credit: Nikita Vance (through Canva)