“People with Borderline Personality Disorder are like people with third degree burns over 90% of their bodies. Lacking emotional skin, they feel agony at the slightest touch or movement.” – M. Linehan, creator of dialectical behaviour therapy.
The impact of the label “Borderline personality disorder”
The label of ‘borderline personality disorder’ is hardly an attractive one. People faced with this diagnosis can experience feelings of shame and embarrassment about who they are, facing a lifetime of judgement from others and themselves.
Personality disorders cannot be diagnosed until a person reaches 18 years of age, but the emerging ‘traits’ can be seen in teenage years.
Very often misunderstood and wrongly represented, people suffering with the condition tend to lead isolated lives coupled with crippling emotions and intense relationships.
Self-mutilation and suicide attempts are frequent symptoms, which receive a label of ‘attention seeking’ from outsiders.
Are these perceptions of symptoms an accurate reflection of what the condition is like to experience?
How are people diagnosed with the condition looking after themselves?
What is the possible treatment for BPD?
And how can others help those diagnosed with borderline personality disorder?
What is borderline personality disorder?
People diagnosed with borderline personality disorder (BPD) often present with symptoms such as deliberate self harm (DSH) and impulsive outbursts. But the main symptom is different.
Sufferers are people that have difficulty adapting to their environments, sometimes due to abuse or neglect, and have very strong emotional reactions to things.
It is important to grasp that borderline personalities are people, just like anyone else, and each sufferer will present quite differently from the next.
It would be a mistake to think that ‘all people with BPD self harm’ or ‘all people with a personality disorder are manipulative’, in the same way that not all psychologists can ‘read the minds’ of others!
There has been a lot of controversy around the label of BPD over the years, and even in the present climate, the DSM-V Committee* has conferred over changing the label and diagnostic criteria. What this highlights is the difficulty even professionals at the top level are having in understanding precisely what personality disorders really are. This filters down into how difficult individual sufferers can be to understand and treat.
What is it like to have Borderline personality disorder?
If someone has a borderline personality, they will always push people away, in fear of getting hurt. This is extremely difficult and painful for the people around them, as the sufferer can seem cold and angry, attention seeking, or not wanting help.
Usually all they are really searching for is the love, care and attention they did not receive as children.
They need to build trusting relationships that will not hurt them. This has a ‘black and white’ pitfall for a lot of BPD sufferers, as they will latch on very quickly to people that seem to give this kind of attention to them.
At this point, a borderline personality may feel euphoric in the belief that there is finally someone who will understand and love them. The downside to this is that the people they hold in such high esteem will always appear to let them down, in the slightest of ways, which to the sufferer is like experiencing the worst pain imaginable.
These feelings of hurt, rejection and shame lead the borderline personality to ‘act out’ in various ways, ranging from self-harm and impulsive behaviours, to suicide attempts – in short, anything to get away from the emotions they are experiencing.
In extreme cases, sufferers are hospitalised to prevent DSH or mutilation which could lead to death. By this point, the sufferer has been through so much pain and emotional suffering, that recovery is a long and drawn out task. These patients could have several suicide attempts behind them together with a long history of physical, emotional and/or sexual abuse.
Inpatients in psychiatric hospitals can have a hard time, as sometimes those with BPD know how to push nursing staff to their limits. Experts at pushing people away, projecting all their anger and frustration onto others, they often are the subjects of apathy amongst mental health teams, who are trying their best to hold the intense emotions on the wards.
Dialectical Behavioural Therapy (DBT) was the model proposed in the 1980s by psychologist and BPD sufferer Marsha Linehan. The model advises a 12-18 month admission to help sufferers build the skills necessary to deal with their emotions.
For example, a sufferer may become very hurt when ‘someone says something the wrong way’. This could be painful for them because they experience this slight of tone as intense rejection of their character, which can lead to an urge to self harm.
With the skills in distress tolerance and emotional regulation incorporated into a DBT programme, the patient can learn how to cope with their emotions and choose to react differently.
Distress tolerance may incorporate different behaviours such as biting into chilis or punching pillows as a substitute to self-harm. Emotional regulation meanwhile looks at labelling and ‘radical acceptance’ of emotions, and engaging in behaviour which is opposite to how the person is feeling – e.g. laugh if you feel like crying!
Mindfulness has come to the fore of mental health in recent years, seen as an adaptive meditation technique. It has proven to be a fantastic tool as part of DBT, to help sufferers live in the here and now, and use the skill of ‘radical acceptance’ when it comes to dealing with intense emotional reactions.
Often, doing less is more. If this approach can be incorporated with compassion for, and understanding of the condition, then the sufferers can learn to trust those around them.
A borderline personality may regularly test people with outbursts such as ‘stop having a go at me all the time!’; ‘I don’t like you anymore’; ‘why are you here?’; ‘what do you want?’, ‘go away’; ‘I don’t want you here’ – to name a few expressions.
It is not easy for people to bear the brunt of this kind of communication, so awareness is key in accepting that these methods of communication are all in aid of testing the integrity of people around them.
This is where validation is key – constantly validating the way the person feels and helping them to label their emotion.
There is no one way to help the people suffering – everyone is different and should be treated as an individual.
That said, there are certain pitfalls to avoid, such as being drawn in too quickly into volatile and intense relationships, and being able to take a step back and accept that no one can ‘solve the problem’.
Try to see the condition not as something that is self-inflicted, but one which has a long drawn out history of emotional neglect and abuse, even if this is not entirely clear. For example, there are some people that have suffered rape and emotional abuse in the family, whereas another person may have had caring family around them whilst growing up, but to them something went so wrong that it felt to them like intense emotional abuse. Neither is better or worse, nor easier to deal with.
One of the hardest things to overcome in a relationship with a sufferer is resistance to change. Usually, sufferers will see emerging traits in teenage years, and are diagnosed before the age of 21. Research has shown that by the ages of 30-35, people seem to start to ‘grow out’ of the condition.
With more adult maturity, sufferers are able to gain insight into their condition and realise that they are able to control their world through positive change, by building different skills.
But until this time, it is almost impossible to ‘change’ a borderline personality. All the people around them can do is offer support, and as much validation as possible.
The most important element of this is knowing where to draw boundaries. Without boundaries, people faced with caring for sufferers are at risk of becoming enmeshed with the condition and feeling like they are failures themselves. Working towards a place where the person is open to change and interested in the treatment options would be a beneficial stance to adopt.
No matter how severe a mental health condition is, there is always a way out – once a person is given the correct support and structure to enable them to take responsibility for their own condition and move on into the world.
*Diagnostic and Statistical Manual of Mental Disorders. Latest release was the 4th edition (DSM-IV), to be replaced by the 5th edition (DSM-V) once the Committee has reached its conclusions based on consultations and recommendations.