What is Borderline Personality Disorder?

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Somewhere you’ve heard the term, perhaps from a friend or a doctor or social media: Borderline Personality Disorder. It’s a mysterious and misunderstood disorder and there are many myths and misinformation floating around out there. So what is it? What makes this diagnosis so difficult to manage? What can be done to help those suffering? I intend to try to answer these questions using my own experience and the information and research currently available, but today, let’s focus on the basics.

For the clinical definition of BPD, a Doctor and/or psychiatrist go to the Diagnostic and Statistical Manual of Mental Disorders, 5th Edition by the American Psychiatric Association (commonly known as the DSM-5). This is a massive book that outlines and details all the indicators and symptoms of every known mental illness and disorder, and is used by physicians all over the world.

It’s hella big.

The first edition was published in 1952, and included things like homosexuality, and pre-menstrual dysphoric disorder. There have been many revisions and changes over the years, with the 5th edition published in 2013, so rest assured the medical profession is well up to date with things like the autism spectrum, gender fluidity, Asperger syndrome, mood disorders and personality disorders.

We’ve come a really long way in treating mental illness, we no longer lock up undesirables in horrific asylums or practice barbaric treatments such as lobotomies or conversion therapy. Don’t get me wrong, our mental health system has loads of room for improvement, but at this moment in time we have never had better understanding of mental illness, or more accessible treatments, resources, and supports.

To be diagnosed with Borderline Personality Disorder, a psychiatrist will identify at least 5 of the following 9 criteria:

  1. Affective (emotional) instability, including intense episodic emotional anguish, irritability, and anxiety/panic attacks.
  2. Anger that is inappropriate, intense, and difficult to control.
  3. Chronic feelings of emptiness, loneliness, boredom, and/or unreactive emotional responses.
  4. Self-damaging acts such as excessive spending, unsafe and/or inappropriate sexual conduct, substance abuse, reckless driving, binge eating, etc..
  5. Recurrent suicidal behaviours, gestures, threats, and/or self-injury such as cutting or hitting.
  6. Unstable self-image or sense of self. Splitting (quick and dramatic shifts between two extremes).
  7. Suspiciousness of others thoughts about you, paranoid ideation, or transient and stress-related dissociative episodes where things appear unreal.
  8. Fear of abandonment; engage in frantic efforts to avoid real or imagined abandonment.
  9. Unstable relationships, alternating between extremes of idealizing and undervaluing people, dependent of clingy behaviours, expectation of negativity.

So, generally, it’s a great big surprise bag of crazy. I myself identify with many of these criteria, but have managed to keep myself relatively safe and healthy with the help of my psychiatrist, therapists, and community supports and family. More about my personal journey later.

By the way, if you recognize these symptoms in yourself or someone you know and think you might have a diagnosis on your hands, please go and talk to your doctor. I can’t diagnose you, all I have is my own lived experience and google (which is absolutely never a substitute for a consultation with a real living breathing health care professional).

Here’s a quick breakdown of what BPD isn’t:

BPD is NOT crazy, insane, lunacy, hysteria, untreatable, burdensome, or too difficult.

BPD is NOT Bipolar Disorder. Bipolar is a mood disorder, like depression or anxiety. BPD is a personality disorder. It is possible to have both BPD and a mood disorder (shout out to all my buddies with that kind of luck!)

BPD is NOT treatable with medication, but it is NOT UNTREATABLE. The treatment is an intensive course called Dialectic Behavioural Therapy. It includes group and individual therapy and can be quite difficult to access and challenging to get through. More about DBT in another post.

BPD is NOT shameful. BPD is NOT your fault. It’s not anybody’s fault. Usually if someone has BPD it could be because of genetics, environment, upbringing, past trauma, a combination of these things or just plain brain-being-weird. The truth is, there is still a lot to learn about the disorder and doctors are doing their best to keep updated as more and more information comes to light. You may never be able to pin down the cause of developing BPD, but that’s not the point. The point is to treat the disorder and get better now.

BPD does NOT mean you are broken beyond repair. Many people who complete DBT find themselves going into remission, so to speak. It is absolutely possible to live a full and vibrant life with BPD.

Don’t forget, whether you or someone you know has BPD, you are not alone. Though this disorder is one of the most misdiagnosed and misunderstood entries into the DSM-5, the treatments are out there and they do work. It will depend a great deal of what kind of health care is available to you where you live, but it also depends on you, and how much work you are prepared to put in to get better. It won’t be easy, but that’s why I’m here. We’re all in this together!

Here we go!