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Understanding Borderline Personality Disorder

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: 

 

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

Cannabis in Canada

If you didn’t know, today is a big day for Canada as marijuana is now legal on a national level!

Here at Bliss, we want to take the opportunity to both celebrate and provide some further information on this new legislation. Although cannabis has been legalized nationally, the laws surrounding legal consumption will vary depending on which province and city you live in. It is your responsibility to know the laws in your city. Some information can be found HERE.

We also want to express the importance of safe consumption. Like alcohol, the laws surrounding cannabis are intended to protect and support appropriate use. At Bliss, we want to remind our readers that the age limits of both alcohol and cannabis are extremely important in order to protect youth as their minds continue to develop.

At Bliss, we want to welcome our clients to speak with us about this new legislation. Whether you are interested in exploring cannabis use, or feel unsure about how to navigate this new legislation, we are here to support you! We feel that at this time, it is crucial to address the importance of having a healthy relationship with cannabis consumption, and we would like to encourage our adult clients who are interested in marijuana to feel comfortable speaking with us about this topic!

We are also willing to work with those who are interested in exploring their concerns about this new legislation, and addressing the difference between healthy and unhealthy consumption. Remember that there are community supports available to you to help work toward a better understanding of cannabis and the laws surrounding its legalization in Canada.

Are you interested in attaining your higher self? Feel free to do so with the support of Bliss Counselling!

Sexy Friday: Toddlers & Sex Positivity, Attachment and Dialogue

 

Thank God It’s Sexy Friday!!

This week, indulge in another episode of “Sex Talk with Kelly” to learn more about raising children in a sex positive environment, and the importance of healthy sex dialogue to help re-spark that romantic attraction! In this episode, Jo Flannery (clinical sexologist) will join Kelly once again, along with a new guest, Anna Gold (relationship therapist).

In order to encourage sex positivity among toddlers, Jo Flannery suggests ‘no judgment zones’ and emphasizes the importance of using the correct terminology when speaking to our toddlers.

Anna Gold addresses issues with the Hollywood idea of a romantic sex life, and emphasizes the importance of real love, and how this can help re-spark a romantic attraction with your partner. She also reinforces the importance of maintaining healthy sexual dialogue with your partner, how to have ‘the talk’, and the importance of creating safe spaces to engage in these discussions.

Interested in learning more about what these specialists have to say? Check out the full episode HERE!

 

Are you a new Sexy Friday reader? We don’t want you to miss anything! Check out our previous Sexy Friday blog posts:

Sexy Friday: Sex After Kids, Low Desire & Anal Play for Beginners

Sexy Friday: The (Not so) Subtle Art of Seduction

Sexy Friday: Pelvic Floor Physiotherapy, Intimacy and Desire

 

Guest Information:

Jo Flannery

Twitter: @SEXOLOGYMag

Instagram: @sexologyint

Anna Gold

Twitter: @SOCounselling

Instagram: @socc_imago

 

Sexual Health & Young Adults on Campus

 

Recently, Sexologist Kelly McDonnell-Arnold invited me on her Rogers TV Talk Show, “Sex Talk with Kelly.” (Airing Wednesday’s at 10:30 pm, on Rogers Cable Network, check it out!) Our goal was to start a conversation around how parents might approach sexual health topics with their adult children on campus. Apparently there’s much to say on that topic, and those 7 minutes really flew by! We felt it was important to encourage healthy sexual attitudes while also keeping safety in mind. Here are a few suggestions on how to continue the conversation, as well as links to some excellent online resources.

What should parents know?

1 in 5 female students will be sexually assaulted while attending university (CFOSO, 2015). What I want to highlight even further, is that for those 1 in 5 woman – it’s likely the assault will be done by someone they know. Keep in mind that females aren’t the only ones at risk to be sexually assaulted. Everyone deserves to feel safe on campus while exploring their sexuality.

What can parents do?

Open the door for conversation. Use media and current events as conversation starters. Encourage them to talk about safety and sexual health with their peers. Are they going to party? Encourage them to talk about safety planning with their roommates before they head out for the evening. Young people are creative and they’ll make a plan that suits them best.

What could parents say?       

“I wrote down a list of all the sexual health resources on campus and I left it on your desk along with some condoms. Remember, sex should be fun but it should also always feel safe.”

This is a BIG topic, so don’t feel like you have to communicate everything about sexual health all in one conversation. Simply being a resource, or linking your children to appropriate resources is a great place to start.

 

Written by Bliss therapist Jenna Luelo. Learn more about Jenna and get her secret “Tips From the Couch” here.

We are thrilled that you’ve found your way to our Bliss Blog, and hope that Jenna’s article has helped you as either a parent or student, prepare for a safe experience on campus! Check out the resources that Jenna recommends below!

 

Resource Links:

Sex and U: https://www.sexandu.ca

Sexual Assault Center: http://sacha.ca/resources/statistics

Local Sexual Health Campus Contacts:

University of Waterloo: https://uwaterloo.ca/campus-wellness/blog/post/sexual-health-resources-or-near-campus

Wilfrid Laurier University: https://students.wlu.ca/wellness-and-recreation/health-and-wellness/self-help-resources.html

Conestoga College: https://www.conestogac.on.ca/medical-care-clinic/education/sexuality

References

Canadian Federation of Students-Ontario [CFOSO]. (2015). Sexual Violence on Campus. Retrieved from: http://cfsontario.ca/wpcontent/uploads/2017/07/Factsheet-SexualAssault.pdf

 

Do you have any questions for us? We’re happy to help! Feel free to get in touch with us here.

If you’re interested in booking your first appointment with Bliss, you can do that here.

 

Sexy Friday: Pelvic Floor Physiotherapy, Intimacy and Desire

Hello and welcome to our Sexy Friday blog series, where Bliss Sexologists will share their extensive knowledge on all things sex! With this new blog series, we hope to take you on a sexploration into uncharted territory, guiding and educating you on all things sex and relationships! Within this series you’ll find links to videos from Kelly McDonnell-Arnold’s “Sex Talk with Kelly”, produced by Rogers TV. You’ll also have access to podcasts and other valuable resources provided by our talented and knowledgeable team! We hope you enjoy this series and look forward to your feedback!

Let’s get this Sexy Friday started!

Today, our blog includes a link to an episode of “Sex Talk with Kelly”, where Dr. Martin Dragan and Jo Flannery join Kelly to discuss pelvic floor physiotherapy, desire and intimacy, and how to start a positive conversation about sex with your partner. Dr. Dragan is a clinical sexologist with a Doctorate in Human Sexuality (DHS). Jo Flannery is also a clinical sexologist and marriage and family therapist, and Co-Founder of Sexology International.

Kelly and Dr. Dragan discuss the value of combining both pelvic floor physiotherapy and sex therapy in order to help clients improve blood flow and to determine what makes them anxious and/or tense, with the ultimate goal being to increase sexual desire and functioning. Dr. Dragan also emphasizes the value of pelvic floor physiotherapy for both men and women, and the benefits it has on overall physical health and sexual pleasure.

Later in the episode, Kelly and Jo have an insightful discussion about the vulnerability that is experienced by many individuals when engaging in discussions of sex with their partner. Jo explains that there are dos and don’ts when it comes to discussions of sex with your partner(s). Most importantly, she articulates that this conversation should never happen during sex, as this is a moment in which you are both most vulnerable. Instead, waiting until you are both in a comfortable space both physically and mentally will ensure that the conversation is productive, not destructive.

To hear more advice from Kelly, Jo Flannery and Dr. Dragan, click here!

 

We are delighted that you’ve taken the time to check out our Sexy Friday blog. Hopefully you learned something new and exciting to make your weekend that much more special! Keep your eye out for next week’s Sexy Friday!

Do you have any questions for us? We’re happy to help! Feel free to get in touch with us here.

If you’re interested in booking your first appointment with Bliss, you can do that here.

Let us help you find your perfect match.

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