Understanding Borderline Personality Disorder (BPD)

BPD is one of the most misunderstood and stigmatized mental health conditions.

"You can't stop the waves, but you can learn to surf." - Jon Kabat-Zinn, MD

"We have over thirty years of research showing that BPD is a trauma-related attachment disorder." - Dr. Janina Fisher

One of my goals as a mental health practitioner is to demystify the presentation of BPD so that those struggling (and/or their loved ones) can better understand what they are experiencing. Knowledge is power.

Dysregulation

BPD is characterized by an ongoing pattern of dysregulation.

There are five types of dysregulation:

• Emotion dysregulation

• Interpersonal dysregulation

• Behavioral dysregulation

• Cognitive dysregulation

• Self dysregulation

Formal Diagnosis and Other Common Symptoms

The American Psychiatric Association's Diagnostic and Statistical Manual of Mental Disorders (DSM-5-TR) indicates that an individual may be diagnosed with BPD if they have five or more of the nine following symptoms:

1. Efforts to avoid abandonment/rejection (a desperate desire for connection and a severe fear of losing it)

2. Emotional lability / dysregulation

3. Feelings of emptiness

4. Identity disturbance

5. Impulsive behaviors

6. Intense anger (with self, others, and situations)

7. Paranoid thoughts and/or dissociative symptoms

8. Suicidal or self-harming behaviors

9. Unstable and intense interpersonal relationships

* BPD Symptoms Not in the DSM:

· Feeling misunderstood

· Self-hatred

· Extreme sensitivity to others’ emotions

· Being “right” over being effective

· Lack of a sense of continuity of time

· Perfectionism

· Being considered “manipulative” by others

"...there are 256 possible combinations of symptoms that someone with BPD might experience, which means that you could be in a room with 255 other people struggling with BPD, and each of you could have a different set of symptoms (Aguirre and Galen, p. 11, 19-22).”

Etiology

The exact cause of BPD is unknown, however, most experts believe it is approximately 40% environment (nurture) and 60% biology (nature).

BPD and the Brain

Individuals with BPD have been shown to have an underactive prefrontal cortex and an overactive amygdala.

Resources:

• American Psychiatric Association. (2022). Diagnostic and statistical manual of mental disorders (5th ed., text rev.). Washington, DC.

• Aguirre, B., & Galen, G. (2013). Mindfulness for borderline personality disorder. New Harbinger Publications, Inc.

• Fox, D. (2021). Complex Borderline Personality Disorder. New Harbinger Publications, Inc.