woman angry photoWhat do you think of when you hear the term “borderline?” What do you think of the term codependent? For most people, borderline signifies a”split,” “switchable,” “unstable,” or “unsure behavior pattern. Codependency, for most, signifies a vulnerability or pattern of unhealthy behaviors.

It’s interesting how the mention of this word can lead to a cascade of reactions in a person.

This article will discuss some common signs of BPD that often confuses those in relation to the person with BPD. I will discuss codependency in the video below as well.

Note: It is also important to keep in mind that BPD can also be frustrating for the person experiencing it.

Individuals diagnosed with BPD can display symptoms similar to or different from other people. Some people diagnosed with BPD experience the diagnosis as “earth-shattering,” while other people may seem very in control and “together. “This is what makes the diagnosis so very hard for others to understand. The clinical picture of BPD can vary greatly across cultures, age groups, genders, and even socio-economic status.

Most individuals with BPD often struggle with managing emotions, making proper decisions, controlling impulses, focusing on the broader picture (ignoring the narrow, negative view of things), and maintaining positive and healthy relationships.

 

Treatment

Treatment is often a challenge as many individuals with BPD may not understand the impact they have on others or on themselves. They may also not believe they have a problem or may engage in minimization of their behaviors. Everyone else is the problem. Everyone else is to blame.

Treating BPD in adolescents can also be a challenge because they aren’t fully developed yet. 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. Treatment must be timely, wise, and appropriate.

 

Confusing Symptoms

After almost 10 years practicing psychotherapy I recognize that a major complaint from family and friends of clients diagnosed with BPD is that they remain uncertain about the person’s behaviors.  They remain in a constant state of confusion and uncertainty when it comes to predicting reactions, moods, or behaviors. Some examples of unpredictable behaviors and emotions exhibited by those diagnosed with BPD include but are not limited to:

  • Emotional chaos and mood lability: It is likely that you know someone who experiences the changeable moods of someone diagnosed with BPD. The moods can range from mild to severe and last for varying degrees of time. 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: 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 meet diagnostic criteria for BPD tend to struggle with controlling their emotions, primarily their anger the majority of the time. Emotional responses may be disproportionate to the trigger. It may be 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 can result 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 into a fitting room without receiving a ticket first.
  • Riskiness or self-harm: Riskiness may include sexual promiscuity, drug-seeking behaviors that place’s 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 entail thoughts of death, dying, and suicide 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 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 sometimes 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.
  • “Impostor syndrome”: Some of my former clients with BPD have explained feeling as if they are “acting on a stage” or playing a role in their lives. They don’t feel like they think they should feel and often struggle with identifying a place in the world. Although I have trouble with this term and doubt its significance due to social media over-psychoanalyzing the term, I think most of society experiences this. But for someone with BPD traits, identity can feel really far away.
  • Insecurity: It’s important to understand that the person with BPD often struggle with body image, low self-esteem, needing validation (especially from men), and being highly influenced by others deemed “sexy,” attractive, or appealing. In some cases, the person with BPD may struggle with boundaries, may become flirtatious or promiscuous, and lost in their own confusion. I remember counseling a family who asked their daughter “why do you always have a man hanging on your arm? Can’t you just be single?”
  • Poor or immature attachment style: In treating youths with strong BPD traits I realized that most of their communication skills are based on their deep needs. An individual who truly needs to feel wanted, loved, or attractive may develop what they strongly believe is love or a “bond” with someone who is unhealthy, degrading, or abusive. They also may struggle in relationships with there is domestic violence, control and dominance, or even sexual abuse and rape.

Codependency and BPD

Most individuals with BPD may also become codependent as a result of poor or unhealthy attachment in childhood, internalized fears, or other similar behaviors. They may be completely oblivious to this fact. Therefore, it is important that we carefully evaluate those we suspect to have BPD and avoid applying a label of “codependent” to them. 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. I explain the concept of codependency a bit further below.

 

 

Do you know someone struggling with BPD and codependence? Stay tuned for my audio blog next week at anchoredinknowledge.com where I will be discussing major relational challenges that individuals with BPD typically experience.

As always, I wish you well

References:
Brain and Behavior Research Foundation. (2017). Frequently asked questions about borderline personality disorder. Retrieved from, https://www.bbrfoundation.org/faq/frequently-asked-questions-about-borderline-personality-disorder-bpd.
Helpguide.org. (2017). Borderline Personality Disorder: A guide to symptoms, treatment, and recovery. Retrieved from, https://www.helpguide.org/articles/personality-disorders/borderline-personality-disorder.htm.
National Institute of Mental Health. (n.d.). Borderline Personality Disorder. Retrieved from, https://www.nimh.nih.gov/health/statistics/prevalence/file_148216.pdf.
This article was originally published June 2017 but has been updated to reflect comprehensiveness and accuracy.
photo credit: SC