Do you know someone with borderline personality disorder? Were you diagnosed yourself? If so,what has been one of the most unsettling features of the diagnosis? For many of my young female clients, the most terrifying part of the disorder, for them, is the emotional chaos and disconnectedness that can occur in moments of intense emotions.
Borderline Personality Disorder (BPD) is a very challenging and complex disorder to treat. Dr. Blaise Aguirre, a recognized child and adolescent researcher of BPD, states that about 11% of clients with the disorder end up in outpatient settings, while about 20% are in inpatient settings with a comorbid diagnosis. For example, someone with BPD may also have severe depression, anxiety, or ADHD.
This article will provide a brief overview of BPD symptoms to look for.
In favor of the final week of Mental Health Awareness Month, I will discuss some of the challenges I have encountered with some clients diagnosed with BPD.
Borderline Personality Disorder affects a large percentage of individuals, about ——. For the spouses, children, parents, grandparents, or other close individuals of those suffering from BPD, life can seem almost impossible to navigate with the individual’s intense (and sometimes explosive) emotional reactions. One of the main challenges I have seen in private practice with individuals diagnosed with BPD is an inability for them to “measure” their emotional reactions to things. For example, I once had an adolescent female, who displayed many BPD symptoms, struggle to identify why most of her emotional reactions were explosive and disproportional to the trigger. Once triggered by a negative statement, a rolling of the eyes from someone, or even a small slight on the road while drying, she would give into long hours of screaming, yelling, and emotional fits. An event that would cause most people to get frustrated and then move on, would cause her hours of emotional distress.
A large number of people with the disorder remain confused, even after years of therapy, as to why they can’t experience their emotions in ways that do not lead to suicidal thinking, suicide attempts, self-injurious behaviors (i.e., such as cutting, burning, scratching, etc), or severe emotional distress. Most individuals with BPD also struggle to identify the culprit that creates chronic relational distress.
In many situations, primarily those I see in my office, involve the individual blaming someone else for their emotional distress. What is often confused as someone else’s fault (“for making me feel this way”) is often the result of an inability for them to control their own emotions.
There are often 5 signs of borderline personality disorder that I look for when seeing clients for therapy. Those 5 signs often include:
- Emotional chaos and mood lability: It is likely that you know someone who is struggling with symptoms of borderline personality disorder. In fact, the National Institute of Mental Health estimates that about 1.6% of the adult U.S. population has BPD. Affective instability, dysphoria, fears of abandonment, confusion over identity as a person, low self-esteem, lack of confidence, feelings of inadequacy, feelings of emptiness, and chronic anxiety or depression are often the hallmark features of BPD. According to the Brain and Behavior Research Foundation (2017):
“For people affected by BPD and their families, both science and psychotherapy are teaching us some things that may not be intuitive, so getting access to experts can be really useful. For just one example, science has taught us that people with BPD interpret a lot of other peoples’ emotions and statements as highly negative and critical. Trained psychotherapists and informed family members who know about this “negative attribution bias” can help the affected person understand that their intentions are actually not so negative. People with BPD can learn consider and weigh the possibility of negative attribution bias when faced with people who seem very critical or angry. “
- Irritability and disproportional anger: As stated above, irritability and affective instability are often at the core of BPD. It is important to understand that not everyone who appears moody or irritable should be diagnosed with BPD. Some people are suffering from other disorders that could better account for their symptoms. However, those who are meeting diagnostic criteria for BPD tend to struggle with controlling their emotions, primarily their anger. Someone suffering from BPD may display emotional responses that are disproportional to the trigger. They may find it completely difficult to control emotions in settings where emotional control is important. It may be difficult to “hold themselves together” until a later time. This impulsivity may have resulted in the loss of employment, relationships, or other important connections. I once had a client who struggled with controlling his emotions in public and would overreact in places such as grocery stores, car shops, malls, etc. On one occasion, my client was asked to leave a mall by police who were called after he threw a store’s clothing down on the ground when he was told he could not take his items in to a fitting room without receiving a ticket first.
- Riskiness or self-harm: Riskiness may include sexual promiscuity, drug seeking behaviors that places the person in harms way, prostitution, overdosing on drugs or alcohol, driving recklessly, gambling, etc. Sadly, self-harm is also included in this category. Self-harm may include cutting, burning, etc. When I began practicing psychology 8 years ago, I had an adolescent client who would bang her head against the walls and ground until she had a headache. After being placed in a 24/7 supervised residential setting, reports showed that she had engaged in this act 4 out of 5 days of the week and would only engage in this behavior when she was triggered by people she thought were abandoning her, bullying her, or going against her in some fashion. No matter how kind I was to her as a therapist, she began to see me as the enemy when I highlighted the values in avoiding self-harm. One minute I was adored, the next minute I was hated. Self-harm can also be seen as self-destructive behavior which may include the individual rejecting the help of others and rejecting mental health or medical care.
- Chronic suicidal thought patterns and/or attempts: Chronic suicidal thoughts may include thoughts of death, dying, and suicide almost everyday throughout the day. It may include what appears to others to be an obsession or psychological preoccupation with all topics related to death. I often encourage parents to watch their children or teens closely when they begin to embrace music, art, or other forms of artistic expression that idealizes, praises, or promotes death, dying, and suicide. Individuals who are considering suicide or who are feeling suicidal, will often gravitate toward those things that embrace it.
- Relational instability: Relational instability may include challenges in almost all relationships the person has. For example, someone with BPD may find it extremely difficult to trust a coworker, a boss, a neighbor, a friend, or even a family member for no apparent reason to outsiders. Their reason, however, may include unjustifiable reasons such as fear of being hurt eventually, fear of abandonment, or even covetousness or envy. Because some individuals with BPD have strong and overpowering emotions, it is possible that someone may find their feelings of envy or jealousy difficult to control as well.
It is important that we carefully evaluate those we suspect to have BPD. Careful evaluation means not jumping to conclusions without professional advice, refraining from angrily telling a loved one that “you are borderline,” and allowing mental health professionals to make that determination. There is certainly a reason why mental health professionals are trained to do what they do. They can fit pieces of a fragmented puzzle together and create a treatment course based on years of research, knowledge, and experience.
Do you know someone suffering from symptoms that may be BPD? Listen to the audio version of this article by visiting my website: anchoredinknowledge.com.
I wish you well