An Emotional Rollercoaster: Understanding Borderline Personality Disorder
Swirling emotions, impulsive decisions, panicked reactions, angry tirades. Borderline personality disorder (BPD) can feel like an emotional rollercoaster.
Once considered an extremely difficult condition, there is hope for those with borderline personality disorder. In fact, with proper diagnosis and treatment, people with BPD can have better outcomes than those with conditions like bipolar disorder or schizophrenia. They are often very bright, intelligent and creative people who struggle with emotional regulation. What they require is understanding, acceptance and professional guidance. I personally find my work with these clients very gratifying.
What is a Personality Disorder?
To understand borderline personality disorder, it’s important to first define personality, which is the combination of thoughts, emotions and behaviors that make you unique. Personality disorder is inflexible and maladaptive patterns of thinking and behaving, which are pervasive in a wide range of social and interpersonal situations. People with personality disorder have poor insight into their conditions and often tend to blame others for their problems.
How Does Borderline Personality Disorder Appear to Others?
From the outside, people with BPD can appear to be engaged in self-sabotage. Disarray tends to follow 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 loved ones also struggle to cope because of their volatile emotions and actions.
People with borderline personality disorder tend to have unstable emotions, relationships and sense of self. They are impulsive and have intense emotions. This causes impairment in functioning at work, school, in relationships and other social interactions.
To others, this can look like impulsivity and irrationality. Their emotions can be volatile and often have intense sensitivity to seemingly trivial issues. Their fear of rejection is so intense that just the thought that someone might leave them can cause an outburst or argument that ruins an entire day. Family members often end up walking on eggshells, which is the title of a book about the disorder: “Stop Walking on Eggshells.”
People with BPD Perceive the World Differently
It’s important to recognize that people with BPD perceive the world quite differently. One research study showed that when people with BPD were shown pictures of faces with different emotions, a neutral face with no expression was perceived as negative emotions such as anger. Other expressions were accurately 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.
Proper diagnosis is essential, as misdiagnosed BPD can lead to delayed appropriate treatment and may affect long-term outcomes. One study stated that over 40% of people with BPD had been previously misdiagnosed with disorders like bipolar disorder or major depressive disorder possibly due to their frequent display of intense angry outbursts, impulsivity and rapidly shifting emotions.
The prevalence of borderline personality disorder in the general population is 1.6%, which is equal for males and females, though in a clinical setting, it is more frequently reported in females. Prevalence in outpatient psychiatric populations has been estimated at 11% and in the psychiatric inpatient population as high as 20%.
Criteria for Diagnosing BPD
A diagnosis of borderline personality disorder requires at least five of the following nine criteria:
- 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 would push loved ones away in the process.
- Intense emotional ups and downs that usually last for hours a 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 and everything hurts them.
- 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.
- Severe self-harming. This can be 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 they 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.
- Feelings of emptiness. Patients describe them as feelings of loneliness, boredom or a sense that “I don’t belong.”
- Intense dissociative episodes. A person with BPD can feel disconnected from oneself and have feelings of unreality. They may have develop transient paranoia under intense emotional stress. Sometime hallucinations may also occur.
- 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.
- Lack of sense of self. People with BPD struggle with having a set of goals and values that are stable. 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.
- 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 that are inherent to BPD have real-life consequences, such as estranged family and friends, relationships ending in breakup or divorce, job losses and even crimes that result in jail time. These can prevent them from leading a life to their full potential.
Therapies Available for BPD
There are many different therapies available for borderline personality disorder. One of the most prominent and effective treatment is dialectical behavioral therapy (DBT) which is a type of cognitive behavioral therapy which helps people identify and change negative thinking patterns while adopting positive behavioral changes. For more on this type of therapy, see “Real Help for BPD: Dialectical Behavioral Therapy.”
With acceptance, correct diagnosis and proper treatment, patients can develop a better understanding about themselves and have much better outcomes in life.
Reach out to CHI Health Behavioral Care professionals for more information.
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.