I want to give more love to people who have or think they might have Borderline Personality Disorder (BPD).
Why? I conceptualize BPD as what can happen when a person suffered from attachment trauma, trauma related to childhood experiences with attachment figures, aka parents, guardians, adults in charge of your care, or even siblings. Attachment trauma can look like extreme child abuse or it can look less severe, like a sensitive child living in an environment with an emotionally unresponsive parent. All the more reason for love.
BPD is demonized, stigmatized, mocked, and othered--even amongst mental health professionals. Historically, people with BPD have been described as hopeless, indulgent young women seeking attention.
This you? BPD Presentation:
People suffering from BPD can be difficult to be in relationships with (romantic, platonic, and family). If you are a loved one of someone with BPD, I do not want to invalidate the difficulty you may have experienced. At the same time, people with BPD are experiencing immense suffering and I can hold both these things as true.
In the DSM-5, Borderline Personality Disorder is diagnosed on the basis of (1) a pervasive pattern of instability of interpersonal relationships, self-image, and affects, and (2) marked impulsivity beginning by early adulthood and present in a variety of contexts which you can read more about here.
BPD presents with deep emotion, and there is something beautiful and moving about that depth of feeling. People with BPD notice subtle changes in their environment and in those they love. Because they have suffered attachment trauma, however, they may overreact to those changes, perhaps panicking or becoming enraged that their relationships are at risk. Essentially, people are very sensitive to the threats to their connections to relationships and community. They are hyper-vigilant at any potential loss. Similar to how most of us conceptualize PTSD victims who might duck after hearing a loud noise, those with BPD may overreact to a subtle change in tone of voice from their partner, a minor comment, or a shift in body language. The feelings can be overwhelming--like they will explode, like they need to sprint or scream or smash something--and this may result in rage, in self harm, in drastic actions to avoid being abandoned. I can’t help but love the deep feeling and very human desire for intimacy in relationships and community, despite the not-so-great strategies to achieve that intimacy.
Okay. What to do? Treatment for BPD:
Dialectical Behavioral Therapy
Dialectical Behavioral Therapy (DBT) developed by Marsha Lineham is generally considered the gold standard for treating individuals who have BPD-type symptoms. DBT uses a systematic approach to treatment starting with increasing mindfulness to notice triggers to emotional reactivity. A trigger for you might be a comment from a partner, a look from your parents, a differing opinion you find offensive. Additionally, mindfulness will include noticing how we react to those triggers. Once those triggers are identified, the therapist and client will begin working on distress tolerance. For instance, we may work on not going down a thought spiral that our partner will leave us and then provoking a fight. Next, DBT teaches emotional regulation skills and interpersonal effectiveness. In therapy, we canwork on ways to soothe your nervous system and better ways to communicate your wants and needs.
A Trauma-Informed Lens. What Happened To You vs What’s Wrong With You?
People with BPD did not get the care or love they needed. This is not their fault. What pain is being acted out when one overreacts to their friend canceling? What needs aren’t being met when someone is overwhelmed with self-hatred? Investigating questions like these is a compassionate and trauma-informed way to seek healing wounds while avoiding pathologizing.
When a therapist focuses on how your experiences of trauma have impacted you versus what is wrong with you, there is room for self-compassion and empathy and, as a result, space for receiving care.
When you’re not constantly judging yourself, that is when there is space to change. P.S. not judging yourself does not mean not accepting accountability. On the contrary, avoiding a shame spiral makes one more prepared to be accountable for their actions.
A Reparative Relationship
Borderline Personality Disorder is a set of symptoms related to psychosocial relational wounds, and therefore is healed in a psychosocial relational setting--for example, talk therapy. Finding a therapist you can trust and who has the skills to support you is crucial in beginning this healing journey. Investigating hurts. Learning new tools, and better understanding yourself are crucial in developing relationships outside of the space of therapy. When you begin to feel safe and stable in relationships you are literally rewiring your brain to react differently in the contexts of relationships. In the case of BPD for example, with practice, instead of panicking at conflict with a friend, you feel safe and secure knowing that relationships can withstand conflict because you have experienced that stability.