By David Joel Miller, MS, Licensed Therapist & Licensed Counselor.
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 abandoned. 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:
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