Just Another Teachin’ Tuesday: Borderline Personality Disorder

Borderline Personality Disorder (BPD) is one of the most misunderstood and abused of the emotional and mental health diagnoses. And what better way to try to turn things around than to chat about it.

I’m going to be using a great book as the foundation for what I have to say. It’s Borderline Personality Disorder Demystified: An Essential Guide for Understanding and Living with BPD, by Robert O. Friedel, M.D. One of the things that makes the book such a great read is Dr. Friedel’s obvious heart for the subject matter. And that’s, no doubt, based in the fact that his sister suffered from BPD.

Well, instead of wasting space discussing the myths of BPD, let’s cut to the chase and swirl around what it actually is. Diagnostically speaking, BPD is considered a Cluster B personality disorder and is placed on Axis II on a multiaxial diagnosis. Yada, yada, yada – much more on the personality disorders here.

Dr. Friedel elects to use the term, “borderline disorder (BD),” and he suggests its presentation is based in physiological and chemical issues; and, certainly, the environment in which one was raised can be a major contributing factor. Interestingly, the term, “borderline,” goes back to the days when it was referred to as borderline psychosis, pre-schizophrenia, pseudoneurotic schizophrenia, and latent schizophrenia. Wild stuff to be sure. And, by the way, BD is not a psychotic disorder.

It’s thought that BD affects 2% of the U.S. population, women three times more than men. And just so there’s no misunderstanding, Dr. Friedel states BD is a, “true medical disorder and, basically, is no more under one’s control than diabetes and hypertension.”

Dr. Friedel helps us understand BD by identifying what he calls The Four Groups of Behavioral Disturbance in BD. He goes on to say that most enduring BD don’t have all of the symptoms in each group; however, they have at least one issue in each of the four groups…

  • Poorly Regulated Emotions – labile (all over the board), hyperreactive (can include “emotional storms”), anxiety, intense anger, inability to control anger, chronic feelings of emptiness
  • Impulsivity – suicidal and self-injurious ideation and behavior
  • Impaired perception and reasoning – memory issues, brief episodes of paranoid thinking, dissociative symptoms, magical thinking, depersonalization, an unstable sense of self
  • Markedly Disturbed Relationships – a pattern of unstable and intense personal relationships, inability to perceive grey-areas in relationships, frantic efforts to avoid real or perceived abandonment

Now that we have a sketch of just what BD is, let’s take a look at its treatment. First of all, a pessimism with regard to BD being treatable at all very wrongly permeates the minds of those personally encountering it, as well as the minds of emotional and mental health “professionals.” Wrong, wrong, wrong. BD is definitely treatable!

Here are some helpful treatment notes…

  • As with any emotional or mental situation, BD sufferers have to take responsibility for managing their lives
  • It’s essential to find a psychiatrist and therapist who are experienced with BD, and who remain current with efficacious treatment strategies and techniques
  • As tough as it may be, those enduring BD have to be open to the possibility of the necessity for different levels of care – hospitalization, partial hospitalization, outpatient
  • Being open to meds – mood stabilizers, atypical antipsychotics, antidepressants – is a good idea (I know, easy for me to say)
  • It’s really important to be open to psychotherapy – individual supportive therapy, cognitive-behavioral therapy, dialectical behavior therapy (a derivative of cognitive-behavioral), interpersonal group therapy, and family work.

So there’s a thumbnail on borderline disorder for “Just Another Teachin’ Tuesday.” And, as always, we need your comments. Won’t you share?