595702_14433699Is borderline personality disorder a real diagnosis or is it just a way to let someone who’s selfish, impulsive and mean off the hook for their bad behavior?

If you’re shocked by the above question, don’t be.

Some therapists will tell you that without education, spouses, children, and especially colleagues of those with BPD might feel the diagnosis is a “sham” or an “excuse for bad behavior.”

This is a shame because BPD is a real disorder and as hard as it is for spouses and children, it is much harder for the person who’s been diagnosed with BPD. The ups and downs of emotion, the fear and panic, the shame, the self-harm are all exceedingly painful to the person with BPD. Life or death neediness, knee-jerk responses to perceived abandonment, sudden rages—these are just a few of the inner stresses people with BPD endure.

Clearly, there is a marked difference between someone who might have a hard time with relationships, or act out in anger, or is occasionally spiteful, and someone who has BPD.

Symptoms of Borderline Personality Disorder

Individuals with BPD usually have several of the following symptoms:

Marked mood swings with periods of intense depressed mood, irritability and/or anxiety lasting a few hours to a few days (but not in the context of a full-blown episode of major depressive disorder or bipolar disorder).

Inappropriate, intense or uncontrollable anger.

Impulsive behaviors that result in adverse outcomes and psychological distress, such as excessive spending, sexual encounters, substance use, shoplifting, reckless driving or binge eating.

Recurring suicidal threats or non-suicidal self-injurious behavior, such as cutting or burning one’s self.

Unstable, intense personal relationships, sometimes alternating between “all good,” idealization, and “all bad,” devaluation.

Persistent uncertainty about self-image, long-term goals, friendships and values.
Chronic boredom or feelings of emptiness.

Frantic efforts to avoid abandonment.

NAMI

Sometimes BPD is misdiagnosed as bipolar disorder, depression, or anxiety. In fact, mental illnesses such as depression, anxiety, eating disorders, and addiction can overlap with BPD.  Dialectical Behavioral Therapy is generally the most effective treatment for BPD.

But What About Using BPD As An Excuse?

Assuming a person has BPD, is it possible that they themselves use their diagnosis as a way to excuse “bad behavior”?

This question finds deep roots in the disorder itself.

A good therapist helps a client develop a realistic view of their symptoms. This includes helping a patient develop an understanding of their feelings, thoughts, and behaviors and when they need to take responsibility for their actions.

Of course, responsibility is different than blame. Responsibility and blame may be indistinguishable to the person with BPD and one of the reasons they suffer. Helping a person with BPD understand the difference between threat and discomfort is also important.

Most people with BPD generally view themselves as inherently no-good, and feel such a deep sense of blame and shame that it becomes easier to avoid all responsibility for behavior by letting it remain unexamined. This is one of the results of the “black and white” thinking that is a hallmark of BPD.

When patients engage in behaviors such as blaming others for all their problems, abusing/condemning people relentlessly, acting out in anger or hysteria, and so on, they are projecting their shame and blame outwards. The other person becomes irrevocably evil in their eyes.

Or they self-harm, because they cannot tolerate their view of self.

Some people with BPD may in fact, find it easier not to control themselves, and then do indeed “let themselves off the hook” by saying, “I have BPD and this is just a symptom. I can’t help myself.”

A skilled therapist can gently help the patient to understand the complexity behind these issues, and can help them develop meaningful definitions which illustrate the differences between unhealthy blame and healthy responsibility.