What is Borderline Personality Disorder (BPD)?
- courtneyfyvolent
- Dec 19, 2023
- 6 min read
As a trauma therapist who specializes in relational trauma including childhood neglect and abuse I have worked with many clients who have either been previously diagnosed with Borderline Personality Disorder (BPD) or who have not been officially diagnosed but objectively meet or have previously met the criteria for this diagnosis. Based upon my trainings and observations in my practice I believe there are many common misunderstandings when it comes to Borderline Personality Disorder and the individuals who experience the cluster of symptoms that make up this diagnosis.
What is Borderline Personality Disorder (BPD)?
Borderline Personality Disorder refers to a cluster of specific symptoms that are very real and can be extremely difficult to manage, particularly in early adulthood. People with Borderline Personality Disorder tend to verbalize struggling with fears of abandonment and a deep inner sense of shame. Lashing out or imagining one’s self lashing out at others may be common when experiencing or avoiding painful emotions, and can contribute to continued feelings of shame throughout life. Dissociating, more commonly seen as ‘shutting down’, (but actually much more complex) is another common symptom that might be observed by others or reported in early sessions.
The symptoms of Borderline Personality Disorder can be extremely painful and should be taken very seriously, however that does not mean that anyone who experiences these symptoms should be seen as broken or incapable of healing. In my experience, people with symptoms of Borderline Personality Disorder tend to be highly sensitive and deeply caring individuals who are capable of doing life-changing work with a well-trained nonjudgmental therapist with whom they feel safe and connected.
What Are the Symptoms of Borderline Personality Disorder?
According to the DSM-5, the latest version of The Diagnostic and Statistical Manual of Mental Disorders, Borderline Personality Disorder is a cluster B personality disorder characterized by a pervasive pattern of instability of interpersonal relationships, self-image, and affects, and marked impulsivity, with symptoms beginning in early adulthood, present in a variety of contexts, and indicated by 5 or more of the following:
Frantic efforts to avoid real or imagined abandonment.
A pattern of unstable and intense interpersonal relationships characterized by alternating between extremes of idealization and devaluation.
Identity disturbance: markedly and persistently unstable self-image or sense of self.
Impulsivity in at least two areas that are potentially self-damaging.
Recurrent suicidal behavior, gestures, or threats, or self-mutilating behavior.
Affective instability due to a marked reactivity of mood.
Chronic feelings of emptiness.
Inappropriate, intense anger or difficulty controlling anger.
Transient, stress-related paranoid ideation or severe dissociative symptoms.
Where Does Borderline Personality Disorder Come From?
As a therapist who has spent many years working with clients who struggle with these symptoms, I believe fully in the idea that these symptoms are a result of a highly sensitive person (an essentially positive trait) having been subjected to an invalidating environment where their emotional needs were not fully met at crucial times in their development. This experience creates a deep inner sense of shame that is then carried into all other relationships in adolescence and adulthood. If we are to say that our relationship with self is the most important one we have, this is essentially a problem for those with Borderline Personality Disorder as individuals attempt to relate to others from this inner sense of shame and instability.
Whether caregivers were knowingly negligent or abusive, or did the best that they could with what they had to offer at the time, some crucial emotional needs went unmet for these individuals which has had a lasting impact on ways of functioning in relationship to self and others. Looked at in this way, this specific disorder is, at least in part, a result of early relational trauma, indicating that trauma work and healing of early attachment wounds can help to repair many of the issues internally and in relational functioning that individuals with BPD symptoms struggle with in adolescence and adulthood.
Can Borderline Personality Disorder be Cured?
Although this condition is not considered ‘curable’ it is a highly treatable condition that generally improves with treatment and with age. I often have clients struggling with the cluster of symptoms classified as Border Personality Disorder come into their first sessions vocalizing concerns they may actually have Narcissistic Personality Disorder (a more rare and very different diagnosis) and are worried they may be incapable of experiencing true empathy for others or engaging fully and whole-heartedly in the treatment process due to struggles with anger and emotional instability.
I am quick to help my clients understand how Borderline Personality Disorder is distinctly different from Narcissistic Personality Disorder and is actually a highly treatable condition. When it comes to long-term success in treatment, according to the DSM-5, studies of individuals identified through outpatient mental health clinics have even indicated that after a period of time as many as half the clients identified no longer met full criteria for Borderline Personality Disorder.
In my experience in private practice, many of my clients report having experienced a significant reduction in symptoms including a reduced or ameliorated sense of shame, increased stability regarding sense of self, and improvements in relational functioning by the end of their time in the treatment process and are able to graduate to monthly or quarterly check-ins/as needed appointments after a period of more intensive treatment.
The frequency and duration of recommended treatment starting out generally depends on the specific client’s needs at the time of the intake session, and will be continually evaluated and collectively determined between client and therapist throughout the therapy process.
How is Borderline Personality Disorder Treated?
Borderline Personality Disorder is most commonly treated through psychotherapy, with medications often being prescribed to address symptoms of co-occurring disorders (e.g. depression and anxiety). It is up to the individual and their prescriber to determine if and when medications are recommended and I encourage my clients to always consult and follow-up with recommendations provided by their prescriber.
Due to the very real and very painful emotions often associated with Borderline Personality Disorder, the psychotherapy process should be done with a trained professional who utilizes evidence-based methods for addressing your specific concerns and who assists with provision of emergency resources and safety planning when appropriate.
Dialectical Behavioral Therapy is shown to be helpful in teaching clients effective coping skills for managing and reducing the symptoms of Borderline Personality Disorder. I utilize DBT skills in my sessions to assist my clients in learning and incorporating emotion regulation skills to use outside of the treatment setting, in order to prepare for trauma work with the use of EMDR techniques when appropriate.
In my practice I like to focus less on the diagnosis itself and more on treating the current concerns of the person I’m working with. Your goals are my goals. This is another benefit I have found of not working directly with insurance companies. In working with me, clients diagnosed with Borderline Personality Disorder or with a history of these symptoms without diagnosis will learn skills for symptom management and reduction with the eventual goal of reprocessing past traumatic events that may have contributed to emotional instability, shame, and other negative beliefs about self. We will work together to identify the origins of your own early attachment wounds and begin the healing process to change how you relate to yourself and others in the present.
What Should I Do If I Think I Have Borderline Personality Disorder?
If you believe you have symptoms of Borderline Personality Disorder, please reach out to a trained professional with experience in treating this specific condition. I recommend finding a licensed therapist with experience working with trauma including early childhood emotional neglect and abuse and training in Dialectal Behavioral Therapy (DBT), Eye-Movement Desensitization and Reprocessing (EMDR), and/or Internal Family Systems (IFS).
When researching this diagnosis, there is a lot of information available online and on commonly used social media platforms on personality disorders including Borderline Personality Disorder, some research-based and some based solely on subjective personal experience and opinion, with some particularly negative misinformation being spread by professionals and nonprofessionals alike.
It is important to be aware of where you are gathering your information and to consult with a professional who specializes in this area. Most professionals who specialize in working with individuals with these symptoms practice from a nonjudgmental stance that assumes that everyone is doing the best they can at this time with the skills and tools they currently have available.
If you are able to relate to the symptoms and experiences discussed above and are looking for outpatient therapy in Greenville, SC please message me below for a consultation call to see if we are a good fit for this next step of your journey.
*This website (healingvalleyscounseling.com) and the information it contains are not a substitute for therapy. This site is not meant to provide treatment advice, only to share general psychoeducational information. If you are experiencing current suicidality or thoughts of self-harming, please contact 911 immediately or go directly to the nearest emergency room.
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