Education

Please note that every person’s experience of borderline personality disorder (BPD) is different. The symptoms and ranges of BPD run both vertically (the number of symptoms experienced) and horizontally (the intensity of how they are experienced). If we also consider other factors that layer and intersect, such as life events (e.g., t/Trauma) and social positions (e.g., financial security, colour of skin, sexual orientation, gender, etc.), our end result is a very unique tapestry of experiences.

“People with BPD are like people with third degree burns over 90% of their bodies. Lacking emotional skin, they feel agony at the slightest touch or movement.”

Dr. Marsha Linehan

What is Borderline Personality Disorder?

BPD is the most common personality disorder listed in the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV-TR). This manual is used by physicians and psychologists to make mental health diagnoses. Someone with a personality disorder typically faces unique challenges in:

• Relationships and social situations;
• Managing emotions and thoughts;
• Understanding how certain behaviours are creating problems and/or;
• Recurring difficulties in changing a mindset to suit different contexts. 

75% of people with BPD self-injure one or more times. 

10% of people with BPD take their own lives.

What are the symptoms of BPD?

The DSM-IV-TR lists 9 categorical criteria for BPD. A person must present with at least 5 of the symptoms in order to be diagnosed with BPD. The 9 symptoms can be summarized as:

1. Frantic efforts to avoid real or imagined abandonment, significant fears of being alone;
2. Unstable and intense interpersonal relationships;
3. Lack of clear sense of identity;
4. Impulsiveness in potentially self-damaging behaviours, such as substance abuse, sex, shop lifting, reckless driving, binge eating;
5. Recurrent suicidal threats or gestures, or non-suicidal self-injury such as cutting, burning with a cigarette, or overdose that can bring relief from intense emotional pain; 
6. Severe mood shifts and extreme reactivity to situational stresses;
7. Chronic feelings of emptiness, loneliness and neediness;
8. Intense, frequent, short-lived and inappropriate displays of anger, depression or anxiety;
9. Transient, stress-related feelings of unreality or paranoia.

Inconsistent symptoms are the hallmark of BPD, which makes it difficult to define a single set of criteria for a diagnosis. This is further complicated, as research has shown that about 90% of folks with a BPD diagnosis, share at least 1 other major psychiatric diagnosis.

What is it like living with BPD?

“Prick the delicate ‘skin’ of a borderline and she will emotionally bleed to death.”

Kreisman and Straus

BPD has been described as emotional hemophilia. In the case of BPD, the client will have difficulties with moderating their feelings. Mood changes can come and go quickly and can shift from extreme joy to the deepest despair. A person with BPD may be filled with anger or despair one hour and then calm the next, with little understanding as to why. This then leads to feelings of insecurity, lower self-worth and inner criticism, which brings about more self-hate and depression. 

Symptoms, such as dissociation, can also interfere with concentration making it very difficult for folks with BPD to complete their tasks. Feelings of emptiness makes a person with BPD feel as though they have to do anything to escape, such as impulsive and self-destructive behaviours, so that they may feel something. People with BPD may also feel as though they do not have a core identity and to overcome their mostly negative self-image, they will create characters or codes.

People with BPD may also experience splitting. Splitting can happen at any time, if they are under enough pressure, stress, anxiety, or anger. Splitting is when a person only thinks about a situation or person in binaries. It is the rigid separation of positive and negative thoughts and feelings about oneself and others. For instance, a person with BPD may only consider a context to be right or wrong, good or bad, or in black and white terms without any room for grey. A person with BPD may struggle to accept human inconsistencies or ambiguities, and as such favour predictability. 

When there is a miscommunication or when somebody they idealize eventually disappoints them in some way, or acts in a way that they did not predict, a person with BPD may look at them as though they cannot be trusted. When this occurs, the person with BPD has to make a decision to either restructure their strict and inflexible conceptualization of this person or to isolate themselves in order to preserve the “perfect” image they had created. 

Research shows that there is no definitive cause for BPD, rather it is a combination of genetic, developmental, neurobiological and social factors that contribute to its development. People with BPD may come from family backgrounds with parents who were indifferent, rejecting or absent. They may have also received little to no affection and/or experienced chronic abuse. 

A person with BPD will also seek out new relationships (i.e., partners and/or friendships) quite often. Once in a close romantic relationship they will both crave and become terrified of intimacy; fearing abandonment, they will cling to their partner, which will then lead to fears of enmeshment, so they push away. Because of this, they end up pushing away those they want to connect with the most. 

Of all the major mental health diagnoses, BPD is the most stigmatized. Stereotypes include viewing folks with BPD as dramatic, manipulative, unfeeling or lacking emotion, attention-seeking and/or narcissistic. They are consistently suspected of wrongdoing, carelessness, anger, and difficulties with building a regular routine. This leads folks with BPD to hide this part of themselves from others. 

For a person with BPD there are significant fears of abandonment and they will attach to a favourite person and rely on this person for emotional validation and security. Their favourite person becomes the source of their comfort and devotion. A BPD person’s favourite person can be anybody: a relative, parent, best friend, lover, or somebody they just met. The difference between a best friend and a favourite person, is related to the intensity of the thoughts that surround this person. 

A person with BPD requires compassion, understanding, acceptance, honesty, patience and love. They may not have grown up with either receiving or learning how to share these characteristics with their formative relationships, so accountability for behaviours that are challenging a relationship and empathy, are key. Of course a person with BPD will need to learn how to give themselves the love and compassion that they crave from others, as well.

What can you do if you or a loved one is experiencing BPD related symptoms?

It is important to recognize that there is no “cure” for BPD, rather somebody who experiences these traits and is receiving treatment may just have more time between self-harm episodes and/or coping strategies to support emotional regulation.

Kreisman and Straus have described a structured method of communication, known as SET that can be used when communicating with a person who is in a BPD related crisis, or emotionally spiralling. 

Support – Use a personal “I” statement of concern to demonstrate a personal pledge to try to support the person in emotional crisis. For example, “I am really worried about how you are feeling.”

Empathy – Acknowledge their chaotic feelings with a “You” statement. For example: “You must be feeling awful/scared/hurt/etc.”

Truth – Emphasize that this person is accountable to their own life and that others’ attempts to help, cannot avert this primary responsibility. In this statement, you must acknowledge that there is a problem that exists and offer a solution for what can be done to solve it. This must be done in a matter of fact tone. For example, “Here’s what happened…These are the consequences…. This is what I can do… What are you going to do?”

It is possible to have a healthy relationship with a person with BPD, especially if you are the favourite person. You can do this in 5 easy steps.

Step 1 : Communicate

The first step is to have a discussion, to acknowledge that you are their favourite person, and to determine if the relationship is mutual.

Questions to reflect on and consider during this discussion are:

1. What are each person’s needs? Are they currently being met? 
2. Has there been an instance where either person’s needs weren’t met, why might that be and how might you both be able to overcome this in future interactions?
3. What are both of your feelings regarding space and emotional boundaries? 

Step 2: Avoid Assumptions

BPD folks generally think in black and white (e.g., “they don’t love me anymore”). In order to avoid this assumption and the potential for an emotional crisis, or “testing” the favourite person to make sure they still do love them or won’t leave them, the BPD person should feel comfortable with being direct and asking for reassurance from their favourite person (e.g., “Is everything alright? I’m just worried because I haven’t heard from you in a while”).

Step 3: Develop More Friendships

It is comfortable and easy for a BPD person to give all of the love and everything they have to their favourite person, but it’s a lot of pressure to receive and also reciprocate as a single human being. This is why it is important for both the favourite and BPD person to have friends of their own that they enjoy spending time with. This will help the BPD person with the intensity of putting all of their emotional needs on one person, and will also help the favourite person to have other outlets and their own support. It’s important that the BPD person avoids scheduling their plans around their favourite person. 

Step 4: Limit Expectations

This is one of the most difficult ideas for a BPD person to incorporate into their worldview, but it is to cultivate a mindset in which their favourite person may leave, by choice or not, and this is okay. This requires a mindful appreciation for enjoying the day for what it is. No matter what happens. It is not possible to control a person or to demand that they be committed to your relationship or friendship forever. Thinking of the future and the possibility that they could leave, may generate anxious thoughts and feelings of being abandoned. Instead, the BPD person can try practicing gratitude for the current state of their relationships. 

Step 5: Therapy & Medications

Treatment for both the BPD and favourite person usually begins with education; discussing what is known about BPD and its causes, as well as how the BPD person can self-manage and prevent relapses. Therapy and counselling may also be offered at the individual or group level for both the BPD and favourite person. The BPD person may also wish to take prescription medications that align with their specific symptoms (e.g., mood swings or anxiety). There are a number of therapeutic tools that can be used in the treatment of BPD symptoms. The 2 major tools are cognitive behavioural therapy (CBT), which focuses on the present and on changing negative thoughts and behaviours, and dialectical behaviour therapy (DBT) which uses concepts of mindfulness and acceptance or being aware of and attentive to the current situation and the client’s emotional state. DBT helps clients to regulate intense emotions, to reduce self-destructive behaviours and to improve relationships.

It’s important to remember that like any relationship, the connection you build will be at it’s healthiest if it is constructed on a foundation of trust, friendship, mutual respect and care, honesty and accountability. 

At Bliss, we want to help our clients navigate the complexities of BPD and help them live balanced, happy, fulfilling lives. If you need additional guidance, please book an appointment with one of our therapists who specialized in this area and will guide you through the therapy process in a safe, non judgemental atmosphere: 

• Sheila Mcdonough
• Sergius Semuyeh
• Valentina Messier
• Josh Rinz
• Marni Moss

You do not have to go through this alone. Bliss is here to support you.

Written By: Jess

Jess is our amazing office strategist at Bliss Counselling. Jess is a Master’s graduate from the University of Guelph. During this degree, they focused on aging and end-of-life, communication, human sexuality, LGBTQI2S+ health, inclusive practice and policies, knowledge mobilization strategies, research methods, and program evaluation.

I would like to learn more about BPD, what other resources exist?

For more information and support, please consider the following resources.

Books

• Beyond Borderline: True Stories of Recovery from Borderline Personality Disorder by John G. Gunderson (edited by Perry D Hoffman)
• Building a Life Worth Living: A Memoir by Marsha M. Linehan
• Coping with BPD: DBT and CBT Skills to Soothe the Symptoms of Borderline Personality Disorder by Blaise Aguirre
• I Hate You – Don’t leave me: Understanding the Borderline Personality by Jerold J. Kreisman and Hal Straus
• Loving Someone with Borderline Personality Disorder by Shari Y. Manning
• Mastering Adulthood: Go Beyond Adulting to Become an Emotional Grown-Up by Lara E. Fielding
• The Dialectical Behaviour Therapy Wellness Planner: 365 Days of Healthy Living for Your Body, Mind, and Spirit (The Borderline Personality Disorder Wellness Series) by Amanda L. Smith
• The Mindfulness Solution for Intense Emotions: Take Control of Borderline Personality Disorder with DBT by Cedar R. Koons
• This is Not the End: Conversation on Borderline Personality Disorder by Tabetha Martin
• The Dialectical Behaviour Therapy Skills Workbook: Practical DBT Exercises for Learning Mindfulness, Interpersonal Effectiveness, Emotion Regulation and Distress Tolerance by Matthew McKay, Jeffrey Wood, and Jeffrey Brantley

Online Documents

• Borderline Personality Disorder: An Information Guide for Families by CAMH 
  • https://www.camh.ca/-/media/files/guides-and-publications/borderline-guide-en.pdf?la=en&hash=69DE097DD9DC16A66440FCD4573E73358AEEECEC
• Borderline Personality Disorder by the National Institute of Mental Health
  • https://www.nimh.nih.gov/health/topics/borderline-personality-disorder/index.shtml
• DBT Skills Training Handouts and Worksheets by Marsha M. Linehan
  • https://projecticee.files.wordpress.com/2018/12/lin-c-dbt-handouts.pdf
• The Overlap Between Autistic Spectrum Conditions and Borderline Personality Disorder by Dudas et al., (2017)
  • https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5590952/