What is Borderline Personality Disorder?


By David Joel Miller.

Bipolar or Borderline Personality Disorder?

People with Borderline Personality Disorder (BPD) experience intense emotional pain and lots of loss in their life. They never feel the faint breeze or the warmth of the sun in the springtime. For the Borderline the world is a place of hurricanes and scorching heat. Life is one horrific storm. They experience terrible loss. BPD may result in interrupted education, ruined or unstable relationships and frequent job loss.

BPD can look like Bipolar Disorder but while the Bipolar person may have months of depression and long periods of elevated mood or irritability the BPD person has all those mood changes in a single day.

Borderline Personality Disorder (BPD) is an often overlooked and misunderstood mental health issues that get placed under the heading Personality Disorders. BPD is coded on Axis II and viewed as long-standing and difficult to treat. Personality disorders often co-occur with other mental health challenges such as depression and Bipolar disorder. Because of the notion that a personality disorder is difficult, if not impossible to treat, there is a reluctance to give clients this diagnosis.

Untreated BPD is viewed as a “pervasive” or inflexible pattern in life and includes four characteristics, unstable relationships, fuzzy self-image, impulsivity and lots of negative emotions. The DSM lists 9 “criteria” or symptoms the client might have but only requires 5 of those nine symptoms to make the diagnosis. In practice, this means a lot of judgment calls.

Most people with Borderline Personality Disorder have some but not all of the “criteria” for the disorder. Gunderson suggests in his book that there are three distinct Levels of Borderline Personality Disorder based on the nature of your relationships with others.

Children experience some mood instability as a normal part of growing up. We expect some BPD characteristic that will go away as they mature. As a result, children are almost never given a personality disorder diagnosis. When the BPD picture seems to be developing, the child may be described as having “Borderline traits.”  Those with untreated BPD generally do not get better with age, the pain they experience grows.

BPD begins in early adulthood and those “characteristics” or “traits” need to occur in multiple situations. This disorder, when treated, generally fades as the person gets older. Women make up 75% of those who get BPD diagnosis and frequently had a diagnosis of Bipolar Disorder prior to being diagnosed with BPD. This disorder is probably underdiagnosed in men because men act out, break laws and get caught abusing substances more often than women. These other problems get diagnosed first and become the focus of treatment.

Treatment for Borderline Personality Disorder is effective in reducing symptoms. Ten years after treatment half of those diagnosed with BPD no longer have enough symptoms to receive the diagnosis though they may continue to have some Borderline “traits.”

There appear to be a number of Causes of Borderline Personality Disorder. Some of the symptoms of BPD are adaptive behaviors that may have worked to protect you and get your needs met when you were younger but as you grow up these behaviors no longer work.

Abandonment is a key issue for those with BPD. They need someone in their life and can’t stand being alone but fear being rejected and abandon. They are constantly on the lookout for signs of potential abandonment. As a result, they may appear needy and drive people away. Their impulsive behavior creates exactly what they most fear.

Someone with BPD is very sensitive to their environment. When things do not go well in relationships they blame themselves and may “take it out” on themselves. Self-mutilating, cutting, burning and suicide attempts are common.

Because of their terrible need for a supportive relationship BPD individuals tend to jump into very close intimate relationships without getting to know the other person. As a result, they over-trust people who should not be trusted and expect more from partners than another person can provide. Once disappointed they become furiously angry. They are often demanding in relationships and need lots of time with their partner. They may have violent emotional reactions when their partner attempts to leave for work, school or errands.

Sudden changes in their opinions of others are common. When let down by those in their life they respond with lots of anger, sarcasm, and bitterness which only drives others farther away.

Many individuals with BPD report they don’t know who they are other than by adopting the values of those around them. They may have sudden changes or difficulty identifying values, goals or career plans. They often self-sabotage. It is not uncommon for someone with BPD to quit school just before finals or leave a job just as they were about to get a raise or promotion.

Living with Borderline Personality Disorder is a horrific challenge for those with this condition and it challenges those who would like to be in a relationship with the person with a Borderline condition. While treatment is never easy it can be effective and result in creating a happy, fulfilled and connected life.

Other posts on Borderline Personality Disorder include:

What is Borderline Personality Disorder?

What causes Borderline Personality Disorder?

Levels or types of Borderline Personality Disorder

Treatment for Borderline Personality Disorder

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For more about David Joel Miller and my work in the areas of mental health, substance abuse and Co-occurring disorders see the about the author page. For information about my other writing work beyond this blog check out my Google+ page or the Facebook author’s page, up under David Joel Miller. Posts to the “books, trainings and classes” category will tell you about those activities. If you are in the Fresno California area, information about my private practice is at counselorfresno.com. A list of books I have read and can recommend is over at Recommended Books

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23 thoughts on “What is Borderline Personality Disorder?

  1. My best friend has borderline personality disorder and it looks nothing at all like bipolar disorder. I have known 2 people with BPD and never saw either in a persistently elevated, hyperactive mood like you get in a manic episode. The mood swings in BPD are far quicker even than ultra-rapid cycling and they tend to oscillate between feeling OK and being mega pissed off. Really the 2 conditions are very dissimilar, except when a person relies on those dog-gone DSM criteria!
    😉

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    • Thanks for those great illustrations of the difference. A lot of people are getting called “Bipolar” by friends or the media who do not have Bipolar disorder. With BPD the mood changes are rapids and mostly in response to something. In Bipolar Disorder the mood swings are extreme and last for long periods of time, sometimes even years. Thanks for commenting.

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  2. Pingback: What Causes Borderline Personality Disorder? | counselorssoapbox

  3. Pingback: Levels or types of Borderline Personality Disorder | counselorssoapbox

  4. At last, a site which admits that BPDs, when untreated and undersupported in their life…only get worse…pain is pain. When we stow it…it becomes suffering, influences our lives in negative ways and becomes a mounting snowball…any pain.

    BPD sufferers burn out when untreated, generally as 40ish nears…then the pain goes deeply internal, and chronic life threatening conditions arise as replacement to the acting out via energy burnout (we only have so much time to engage in abuses like that.)

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  5. Pingback: Lady Diana, Bipolar and Borderline Personality Disorder | counselorssoapbox

  6. Pingback: DBT Treatment for Borderline Personality Disorder – Dialectic Behavioral Therapy | counselorssoapbox

  7. Pingback: Which border is Borderline Intellectual Functioning on? | counselorssoapbox

  8. I have believed since 2006 that my SO has BPD. There seems to be a desire to want to enjoy life but an ingrained inability to be receptive to looking at things in a way that will enable him to enjoy what is. Almost anytime I have or try to offer an alternative viewpoint he gets angry because he feels like I am putting him in the wrong or invalidating him. If a comment can be interpreted positively or negatively, negative will be chosen.

    Our history together, almost 17 years, and his history before could be the textbook example of what you have described.

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      • Thank you. Being this honest is currently placing me on the defensive with a well-intentioned, but misguided friend. She basically just recommended ECT to me for my depression because Princess Leah does it. She has decided that my SO is an abuser and that I am his willing victim. It frustrates me how all the PSA service announcements and awareness campaigns tend to oversimplify things and vilify people who need and could benefit from treatment as well as a tendency to promote people’s tendency to treat “victims” as though they are incapable and incompetent if they don’t kowtow to the common creed.

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  9. Hi David, how’s things?
    I’m Bipolar and BPD and boy did I feel you just wrote about me. The only thing I don’t do is get angry with anyone. I’m the one that takes it out on myself, i’m my biggest enemy and worst critic.
    I have a problem trusting people so there I’m a little different too, but that comes from being abused. Great article and very informative for those who don’t have an understanding of the disorder. Have a great weekend, hugs Paula xxx

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  10. I agree with the Rambo above, as well as the writer. There is alot of info out that says BPD females (males are no different) get more mellow etc. This shows that one making such a claim has no understanding of how pain occurs/matures, zero. The brain of a BPD individual is “DISRUPTED.” it is like an ice cream cone with 3 small primitive ”
    scoops” and no developed “BIG scoop” over them (the big scoop being higher brain). The degree of disruption can be infantile (the worst, and causes can be neglect or shaking a baby…imagining shaking a baby in the development stage where it thinks mommy IS me…and then ” I must be self destructive then???”) or early childhood. When it occurs later, in adult life, such trauma it is termed PTSD.
    As those with trauma age ( whether PTSD or early childhood BPD or infantile BPD), the stress causes chronic high cortisol early in life (among other internal reactions), and then later in life, adrenal fatigue-low cortisol after. This occurs, for most between…wala…35-40..the “mellowing period (yah right!). It is the gateway to pure hell for them, and it plays out like this…
    In the first half, the high cortisol (caused by overreactions from a disrupted brain development) suppresses immune function/and is also an antiinflammatory (among other reactions). so BPD ragers may get alot of colds etc. Cortisol also wears away at the brain, as it is not meant to stay in the blood for long- it is a stress pump to get away from Dino! Notably, but not exclusively affected is the hippocampus, which is responsible for certain memories, often related to those connected to emotional contact. So, in the first half of life, BPD sufferers rage, explode outwardly, are prone to getting sick.

    In the “mellowing” period (yah right…is a tragedy not to tell them that the second Tsunami is coming if they do not get help…qualified (if they can find it) help.) When the cortisol takes a dive, the immune system over activates, and the inflammation response kicks in too. What this causes…you may have guessed it…auto-immune disorder smorgasboard. Rheumatoid arthritis, lupus, anemia,Hashimotos, Graves, Addisons, diabetes etc etc.etc. Round midlife if you have pumped too much cortisol, you can make your own auto immune cocktail. Do not believe the “experts” as it will not “level off.” At midlife (which is early for the BPD) the BPD stills reacts to stress similarly in the ice cream cone brain, though the engine (cortisol) needed for rage is dying or dead…so they get depressed (anxiety’s shy sloth-like cousin). And the cycle of health ailments can consume their addictive psyche. There are also other cascading effects that occur, and books have been written on stress effects in the body as it ages on chronic stress reactions.

    As this plays out longer…there is a third stage (if they haven’t killed themselves in stage one, and survived stage 2’s debilitating or life threatening diseases. As the hyppocampus shrinks…end game….brain dementia, or alzhiemers etc.

    To lump all BPDs as having the same severity would also be a tragic mistake, as they are as varied as people can be. However, to lie to them, and tell them “midlife gets better,” does not “push the envelope” with the truth that, “if you do nothing you will get worse and worse and worse and die. If it were me, and I knew this, I would seek help, and make it a top priority surely before 40.

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  11. Thank you so much for posting this. I have been diagnosed with major depression and unspecified personality disorder with borderline and schizotypal traits. I had a very traumatic childhood growing up with a mother who was struggling with her own issues as well. I have sabotaged anything good coming to me with self-doubt, insecurity, and unexpressed anger. I have had spells of severe paranoia and dissociation and lost friends and family who I deeply cared about it because of it. Yet there is no way to explain such behavior to someone who lives in reality, and sometimes I have even made up stories to cover up for what I cannot explain (which makes me feel even worse…and is also quite obvious to others). I have now devoted my time to raising my son and working on myself for a little over two years now. I completed a two year program specifically for personality disorders, and now I have a therapist who I see twice a week. I think about ending my life often, but I don’t have the courage and I could never do that to my son. I do not feel confident about much, but I believe I am a good mother despite everything. My son seems quite healthy and has almost surpassed me in emotional maturity 😉 All this aside, I just want to say that I personally have an issue with the term “recovery” – it implies a return to a previous state of normalcy, and this is something I have never known. I prefer the term “transformation”.

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    • Thanks for reading and for your comments. No word really captures all that happens when people grapple with a mental, emotional or behavioral disorder. Not sure about transformation as this implies to me that it happens and then is done. I think of recovery not as a return to anything but as continued growth in spite of whatever you see as your problem. Best wishes.

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  12. Hi…I have been diagnosed with Bipolar 2 recently. I am age 46 years being a medical doctor myself..I sometimes really doubt my diagnosis..is it Bipolar or BPD?

    Cos if I have nothing that irritates me I can be very very wonderful but if some thing pisses me off I can get real depressed.
    I dont fly into rage cos I seldom have anger but its more of irritability.
    At the same time when I have depressive moods that can last 1 week or shorter… sometimes if its nearby my menses I can get pretty suicidal and moody that everything seems very bleak and hopeless.

    Then when the depressive phases lifts I feel as if a curse has been lifted and I get talkative and happy and creative…write wonderful poetry too in the happy phase.

    But some months I am just normal..no Jekyll and Hyde at all but there are days where I have 2 moods a day Happy and Depressed and it can keep changing depending if I had a trigger.

    I have a problem with staying connected emotionally with anyone..even though I am a very compassionate person who has cried when I see people unfairly killed and can cry when I see a dog dead on the road…yet at times I feel insecure in any relationship…fear I would be left alone.

    When younger I was a serial monogamist sorts..totally unable to be sans a partner but I am on the constant look out for a stand by person in line in case a relationship does not work out I can have a smooth transition into another without feeling depressed.

    I hate to be alone but neither can I stand crowds.

    So even though I am married I get emotionally connected to others just to feel secure even though I had a perfect childhood..being the only daughter…the middle child and have 2 brothers..I was showered with love and attention yet I grew up insecure.

    Career wise..even though I am good at my work..I do not like to be totally in charge..prefer to work alone but not be the leader.

    I help others become the leader..good at grooming others but I will never take the lead cos I always want to play 2nd fiddle cos its easier on my mind.

    Its strange that I am more capable than many I have groomed yet I dare not be totally in charge.

    So I really wonder…what am I? Bipolar or BPD or a Tango of both?

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    • The situation you’ve described there it would probably take a number of sessions with the therapist to do a full assessment and arrive at a diagnosis. Since I haven’t met you I can’t give you a specific answer to your situation. Some general ideas. There’s a big difference between personality characteristics, like being introverted or extroverted, and a diagnosable mental illness. Whether either of the disorders you mentioned or something else would get diagnosed depends on how much it’s interfering with your function. It’s also common for people to have more than one emotional or mental disorder. Many people will experience three or four separate disorders. I would suggest seeing a local therapist to explore these issues. You may have one, both, or neither of these problems or it could be something else. Even if these issues are not impairing your functioning it may be well worth exploring them. Someone doesn’t have to be mentally ill to benefit from personal growth and exploration. I hope that helps someone.

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