5 important things to know about BPD
Borderline personality disorder (BPD) affects about 2-3% of the adult population and too many with the disorder commit suicide (8-10%). Borderline is an old and misleading term meaning “on the border of neurosis and psychosis.”
As a psychiatrist who has worked with many people afflicted by this disorder, I’m here to give you 5 important things to know about BPD so you can encourage anyone who is battling it to keep reaching for wellness.
We all deserve wellness.
1. Having borderline is not the person’s fault.
Nobody actually wants a disorder characterised by unstable relationships (loving someone one minute, hating them the next), an unstable sense of self (who am I really?) and unstable moods (ruled by anger and strong needs). Who wants to fear abandonment or being alone? Who wants to feel so empty, angry and out of control that they engage in risky behaviour, harm themselves or perhaps become suicidal?
No-one.
It’s not the person’s fault.
Maybe they were born with an over-responsive fear response (that’s one theory), or they experienced trauma early in life (as if often the case), or maybe something went wrong in the peaceful-loving-nurturing stuff all children need. Sometimes a personality gets a little “stuck” at the age of trauma and display tantrums, tempers, clinginess and manipulation now.
We’re refining our understanding but I can definitely tell you …
The person is not the problem.
Borderline is the problem.
It’s a diagnosis, not an insult, not a judgement, not a prison sentence. The real person lies somewhere underneath the symptoms. We aim to understand and encourage the person whenever possible in their battle against the disorder.
2. Borderline responds well to psychotherapy
People with BPD can get depressed and anxious and this often needs medication, but BPD itself is a disorder more of personality development, not brain chemicals. It’s always treated with psychotherapy (plus or minus medication when needed). Research continues in this area. With therapy and effort, people improve immensely. I’ve seen it.
3. Famous people have battled borderline.
There’s a lot of stigma attached to BPD. Very few people put up their hands to say I’ve got it. Some bravely do (mainly comedians, I notice). Websites infer that some celebrities have BPD based on their addictions, disorganised lives, multiple relationships, or self-cutting. Maybe. Maybe not. Let’s leave it for someone to share a diagnose if they want. let’s be understanding and sympathetic.
It is always a problem to battle and, eventually, overcome.
One celebrity who overcame BPD is psychologist Professor Marsha Linehan. Early in life, she was misdiagnosed and misunderstood. She thought about what would help her and through her own experience and expertise she developed Dialectic Behaviour Therapy. This remains the best available treatment for BPD. She is a hero in my industry. She battled. She won.
4. Treatment takes effort, commitment, and understanding.
Outpatient treatment is best for people battling borderline: Dialectic Behavioural Therapy, CBT, insight-oriented psychotherapy, schema therapy, mentalization-based therapy and others. Get it treated to overcome it. Therapy take effort, commitment and understanding but it is worth it. It can take as little as a year to overcome mild to moderate BPD, to many years to help manage severe BPD. Encourage anyone with BPD who is in therapy. Their efforts are worth celebrating.
5. People with borderline are as wonderful as the rest of us.
Do you ever get angry, resentful or mildly manipulative? I do. All of us have a smidgen of borderline, unless you have a perfect personality and had a perfect upbringing. Nah. If you’ve been hit hard enough and early enough, the result could be BPD.
There but for the grace of random chance go I.
People with BPD need understanding and acceptance; the borderline needs treatment. It’s a difficult disorder with symptoms in the getting-on-with-people area. Don’t judge a person based on their borderline behaviour, even if you need to protect yourself sometimes.
Underneath the symptoms lies a wonderful person. I’ve seen this time and time again. As a psychiatrist, I work with that wonderful person to battling the borderline. People overcome it by developing resilience and skills the rest of us may never reach.
It’s a worthwhile journey.