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An Emotional Rollercoaster: Understanding Borderline Personality Disorder

By Harmit Singh, MD January 20, 2020 Posted in: Mental Health

Swirling emotions, impulsive decisions, panicked reactions, angry rants: borderline personality disorder (BPD) can feel like an emotional rollercoaster ride.

Once seen as an extremely difficult condition, there is hope for people with borderline personality disorder. In fact, people with BPD can achieve better outcomes when properly diagnosed and treated than people with conditions such as bipolar disorder or schizophrenia. 

BPD patients are often very bright, intelligent and creative people who struggle with emotional regulation. What they need is understanding, acceptance and professional guidance. I personally find my work with these clients very enjoyable.

What is a Personality Disorder?

In order to understand BPD, it is important to first define personality, which is the combination of thoughts, emotions and behaviors that makes you unique. Personality disorders are inflexible and poorly adapted thought and behavior patterns that predominate in a variety of social and interpersonal situations. People with personality disorder have poor insight into their conditions and often tend to blame others for their problems.

What does borderline personality disorder look like to others?

From the outside, people with BPD can appear to be involved in self-sabotage. Chaos follows them in the form of relationship struggles, job losses and other problems. Not only is it challenging to live a fulfilling life with BPD, family members and relatives also struggle to cope with it due to their fleeting emotions and actions.

People with borderline personality disorder are prone to unstable emotions, relationships and self-esteem. They are impulsive and have intense emotions. This leads to impairments at work, at school, in relationships and other social interactions.

For others, this can look like impulsiveness and irrationality; their emotions can be fleeting and often have an intense sensitivity to seemingly trivial issues; their fear of rejection is so strong that the very thought of someone leaving them can trigger an outburst or argument that ruins an entire day. Family members often walk on eggshells, as the title of a book on the disorder, "Stop Walking on Eggshells," suggests.

People with BPD perceive the world differently

It is important to recognize that people with BPD perceive the world very differently. A research study showed that when people with BPD were shown images of faces with different emotions, a neutral face without expression was perceived as negative emotions such as anger. Other expressions were correctly interpreted as angry, sad and happy. This affects their relationships, as they may often misinterpret other people’s motives and have difficulty trusting them.

Diagnosis of borderline personality disorder

What causes borderline personality disorder is not completely understood. There are genetic and environmental factors. An estimated 70 to 80% of those with BPD have a history of neglect and/or trauma.

Correct diagnosis is critical, as misdiagnosed BPD can delay appropriate treatment and affect long-term outcomes. One study found that more than 40% of people with BPD were previously misdiagnosed with disorders such as bipolar disorder or major depressive disorder, possibly due to their frequent depiction of intense anger, impulsiveness, and rapidly changing emotions.

The prevalence of borderline personality disorders in the general population is 1.6%. This is the same for men and women, although BDP is more common in women in a clinical setting. Prevalence in outpatient psychiatric populations is estimated at 11% and in inpatient psychiatric populations at 20%.

Criteria for the diagnosis of BPD

A diagnosis of borderline personality disorder requires at least five of the following nine criteria:

  1. Fear of abandonment. People with BPD will exhibit frantic efforts to avoid abandonment that is perceived or real. They become very insecure in relationships, and sometimes will push loved ones away as a result.
  2. Intense emotional ups and downs that usually last for hours to days and fluctuate rapidly. Depression can turn into hopelessness and suicidal thoughts, anxiety into panic attacks, and anger to aggression. This may seem as if they have no "emotional skin" like a burn victim to whom everything hurts.
  3. Intense anger/outbursts. These can cause some real damage to their friendships, job prospects and relationships with loved ones and also sometimes land them in legal troubles. These outbursts are what cause loved ones to feel they are walking on eggshells, as they try not to upset a person with BPD.
  4. Severe self-harming. This can involve cutting, burning, picking at skin, or even excessive tattoos or piercings. It's important to note that it is non-suicidal self-harm. These self-harm behaviors release endorphins - the opiates of your brain - which create a sense of wellbeing. For that reason, people with BPD often report that self-harm gives them a relief from emotional pain, or they sometimes say these behaviors are the only way they can feel something. Not all people with BPD exhibit self-harm behaviors. Recurring thoughts of suicidal behaviors or threats are also common and people with BPD are at high risk for suicide attempts.
  5. Feelings of emptiness. Patients describe them as feelings of loneliness, boredom or a sense that "I don't belong."
  6. Intense dissociative episodes. A person with BPD can feel disconnected from oneself and have feelings of unreality. They may have developed transient paranoia under intense emotional stress. Sometimes hallucinations may also occur.
  7. Impulsivity in at least one area of life. People with BPD often have poor impulse control and display behaviors like substance abuse, overspending, unsafe sexual behaviors, reckless driving and binge eating.
  8. Lack of sense of self. People with BPD struggle with having a set of stable goals and values. They might bounce from career to career or from relationship to relationship. They often have low self-esteem and often feel they do not deserve anything good to happen in their lives.
  9. Unstable relationships with loved ones. Their relationships swing from extreme idealization to extreme anger and devaluation. This, accompanied with insecurity and rejection sensitivity, leads to tumultuous, intense relationships. They often have a black or white thinking and struggle with grey areas.

Symptoms can have consequences

The symptoms inherent in the BPD have real-life consequences, such as estranged family and friends, relationships ending in separation or divorce, job losses, and even crimes that lead to prison sentences that can prevent them from fulfilling their full potential.

Available Therapies for BPD

There are many different therapies available for borderline personality disorder. One of the most prominent and effective therapies is dialectical behavioral therapy (DBT), a type of cognitive-behavioral therapy that helps people to recognize and change negative thought patterns while accepting positive behavioral changes.

With acceptance, correct diagnosis and appropriate treatment, patients can develop a better understanding of themselves and achieve much better results in life.

Reach out to CHI Health Behavioral Care professionals for more information.

Harmit Singh, MD
Harmit Singh, MD

Harmit Singh, MD joined CHI Health Psychiatric Associates in August 1, 2013. Dr. Singh is fluent in three languages including English, Hindi and Punjabi. Dr. Singh enjoys cooking, cricket, listening to music and watching movies. He also likes spending time with friends.

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