BY JEN MAKIN CMHC
Borderline Personality Disorder, or BPD, often has tell tale symptoms but they can be hard to identify due to other issues taking precedence. Most research shows that girls and women with BPD have co-occurring disorders, or other mental health disorders, on board simultaneously.
Some co-occurring disorders could be: Post-traumatic Stress Disorder, Bipolar Disorder, Generalized Anxiety Disorder, substance abuse disorders or any other combinations of mental illness.
BPD IN REAL TIME
A 19-year-old woman is struggling with heavy drinking. Loved ones have a rave concern about the amount of alcohol use she consumes. Historically, they focused on her sobriety, finding a therapist and other providers that specialize in substance abuse.
However, in many cases, substance abuse can be a symptom of BPD. While it’s absolutely imperative to focus on sobriety, many therapists focus too much on the drinking, or other mental health issues, and not enough on the root of the problem, BPD.
This doesn’t mean that everyone who drinks has BPD, it’s simply pointing out the importance of therapists doing a proper screening for all symptoms, not just sobriety. It’s also a call for loved ones to dig deeper and become educated about the prevalence of BPD and that it may be presenting with substance abuse or other mental health challenges.
Here’s the rub, if a girl or woman has BPD, it is vital that she is stable prior to focusing on treating her symptoms. To me, it’s like a rollercoaster. If someone next to you is having a seizure while the coaster is going, you have to stop the coaster first to treat the seizure. The coaster represents other co-occurring disorders that are causing instability and then the seizure, or BPD, is the primary focus.
CRITERIA
According to the DSM V, which is the Diagnostic Criteria manual that I use, amongst my other fellow clinicians, the criteria is broken down as such (American Psychiatric Association, 2013):
Fear of abandonment
Unstable or changing relationships
Unstable self-image; struggles with identity or sense of self
Impulsive or self-damaging behaviors (e.g., excessive spending, unsafe sex, substance abuse, reckless driving, binge eating)
Suicidal behavior or self-injury
Varied or random mood swings (happy one minute, then sad the next)
Constant feelings of worthlessness or sadness
Problems with anger, including frequent loss of temper or physical fights
Stress-related paranoia or loss of contact with reality
FEAR OF ABANDONMENT
This symptom can be baffling to loved ones because girls and women with BPD often push close friends and family away by name calling, physical assaults or verbally harming their loved one in some way. Then, within moments, hours or days, the loved one begs you to come back. This boomerang effect often feels like emotional whiplash and can be exhausting, draining and destructive to relationships.
UNSTABLE OR CHANGING RELATIONSHIPS
Rocky relationships. This symptom is a hallmark for BPD. Most Borderlines lean toward the dramatics when they come up against firm boundaries. Sometimes they go into victim mode and create chaos in relationships, engaging in push and pull behaviors. Think of a hurricane, the Borderline sits quietly in the eye of the storm with the storm raging around her, believing she is a victim of everyone else’s choices.
UNSTABLE SELF-IMAGE; STRUGGLES WITH IDENTITY OR SENSE OF SELF
Women with BPD struggle to hold down a job and have a shaky sense of self. They have poor self-esteem and often use negative self-talk, which can be challenging to be around. No matter what you may say, they may become argumentative, causing the push-pull within the relationship. Always seeking and searching for the meaning of life, life’s purpose while having a shaky sense of identity portrays BPD.
IMPULSIVE OR SELF-DAMAGING BEHAVIORS
This topic is tricky because impulsivity is defined as “acting without thinking.” This can carry over into many areas, including into relationships (not maintaining healthy boundaries), overspending and reckless driving. Acting out happens when Borderlines are unable to talk out and identify their feelings. This acting out can be in the form of engaging in impulsive behaviors in many forms.
SUICIDAL BEHAVIOR OR SELF-INJURY
Cutting can come in many forms. The traditional way of cutting is using a sharp object to cut oneself, such as on a limb, causing superficial wounding. Borderlines have continual suicidal thinking, gestures and may make continual threats. These behaviors can cause confusion for loved ones to navigate and identify what is real and what is a BPD incident.
VARIED OR RANDOM MOOD SWINGS
Unlike Bipolar Disorder, where manic or depressed moods last at least four days, moods within BPD can last for hours or a few days. These moods can be anxious, angry, depressive or in the form of a temper tantrum (almost hysterical). Girls and women with BPD can exhibit behavior that can be volatile with labile emotions, like a tornado coming into a room.
CONSTANT FEELINGS OF WORTHLESSNESS OR SADNESS
Feelings of emptiness can entail a Borderline girl or woman can overwhelm them completely. In essence, it’s like a bottomless well that cannot be filled. Borderlines can attempt to fill this well through sabotaging themselves continually or inviting strangers into their beds in an effort to feel something. Triggers can come from anywhere, pushing the Borderline into deep despair and feelings of emptiness.
PROBLEMS WITH ANGER, INCLUDING FREQUENT LOSS OF TEMPER OR PHYSICAL FIGHTS
Angry outbursts aren’t always physical. Combativeness can be emotional warfare for loved ones. A conversation can be about something as simple as a grocery list and ends with tears, name calling and meltdowns. This can be very confusing for loved ones to navigate as the anger seems to come out of nowhere and have no rhyme or reason. It is the responsibility of the Borderline to identify the cause of the anger and manage it.
STRESS-RELATED PARANOIA OR LOSS OF CONTACT WITH REALITY
When someone with BPD faces various stressors, their brain can break in a way. For instance, a Borderline may adhere to beliefs that are not true. One example may be that they believe that individuals dislike them or are talking about them. This can be very painful to believe that things are not real. Reality testing is very important for stabilizing BPD as it helps Borderlines identify reality and re-stabilize.
SPLITTING DEFINED
Splitting is placing someone into a category: good or bad / hero or villain. This way of thinking usually is triggered if a woman with BPD faces something she doesn’t like, such as criticism or strong feedback, she will split and begin to think in extremes. This way of switching can happen on a dime, quite quickly. On one side of the coin the Borderline is sweet, rational and nice to be around; the other side of the coin the Borderline is difficult to be around, explosive and seeing the world in black and white.
SELF-INJURY IDENTIFIED
Cutting is defined by someone using something sharp to harm themselves. An example of this can be cutting with a razor or pair of scissors (anything sharp). In most cases, women with BPD say that cutting relieves feelings of emptiness, anxiety and stress. If you notice that someone is wearing long sleeves when it is warm outside, this may be a clear sign that they are engaging in self-harming behaviors. Approach it gently, never with shame, and allow them to talk freely about their experience to gather information. Then get them professional help.
FOOD FOR THOUGHT
It is important to understand Borderline Personality Disorder in an effort to educate yourself, not use as a weapon. If you or someone you know has BPD, the best thing that you can do is learn all you can and get treatment. Its important to learn positive coping skills to help with emotional regulation, distress tolerance and overall symptom identification and treatment.
No one knows the root cause of Borderline, just that it is a dysfunctional way of coping. Instead of talking out feelings, girls and women with BPD act them out. Talking things out in a safe location and way is the first step to healing. Not losing your temper or control of yourself as a loved one is a great first step to create safety and allow healing.
Find your voice and never lose it.
REFERENCES:
American Psychiatric Association. (2013). Personality disorders. In Diagnostic and Statistical Manual of Mental Disorders (Fifth Edition ed.). Washington, DC: American Psychiatric Publishing Inc.