What is Borderline Personality Disorder?
Borderline Personality Disorder is an officially diagnosable group of symptoms that is characterized by low self-esteem, extreme efforts to avoid abandonment, impulsivity, emotional reactivity, a weak core identity, intense relationships, poor interpersonal boundaries, frequent, recurring thoughts of suicide, suicidal attempts, and self-harm (cutting, burning, head-banging, etc). According to the American Psychological Association, Borderline Personality Disorder is diagnosed in as much as 2% of the population.
Causes of Borderline Personality Disorder
So, why do people develop Borderline Personality Disorder?
Roots in childhood. Borderline Personality Disorder develops during early life, when a person attempts to get their basic needs (love, food, attention, etc) met by their caregivers through conventional means (talking, crying, seeking reassurance, etc), but is unsuccessful. The child may over time realize that more extreme methods of getting their caregiver’s attention (grossly embellishing events that took place that day at school, for example) are more effective.
Invalidating Environment. Part of a person’s needs from their loved ones are to feel seen, heard, and understood. When a child grows up in an environment in which their emotions are routinely dismissed (‘boys don’t cry’, ‘don’t be such a scaredy-cat’, ‘you need to grow up’, etc), they receive the message that emotions are an abnormal part of human life. Depending on how frequent and severe these invalidations are the person can grow to develop an extremely negative internal dialogue and an unstable sense of self.
Sexual Abuse. Victims of sexual abuse experience an extreme loss of control and invasion of privacy. If the abuser is a close relative or other esteemed member of the community to whom the person has grown attached, the person can develop a deep confusion about boundaries in relationships, and develop a distorted view of what is and isn’t appropriate in relationships in adulthood.
Managing Borderline Personality Disorder
My favorite techniques to use with clients who have symptoms of Borderline Personality Disorder – because they are so helpful in both reducing the emotionally reactive symptoms of the disorder and in helping clients tolerate their intense feelings of distress – come from a therapy style called Dialectical Behavioral Therapy, which was developed specifically to treat symptoms of Borderline Personality Disorder. Here are some of the interventions used in Dialectical Behavioral Therapy:
1. Mindfulness. By taking a moment to become aware of one’s thoughts, emotions, and triggers, especially in response to anger or perceived feelings of abandonment, a person can both validate their experiences in the present moment, as well as reduce their impulsivity. Mindfulness can be practiced in a number of ways, from journaling, to guided meditation videos on Youtube, to behavior tracking sheets, to just taking 5 minutes to make a mental note of what you are experiencing.
2. Assertiveness Training. Being assertive means communicating in a way that is clear, honest, and respectful – of both others' rights as well as one’s own rights. A person who has Borderline Personality Disorder can figure out with their therapist what exactly they want to get out of a particular interaction with the other people in their environment, and then figure out how to achieve that goal in a way that respects their own rights and feelings, as well as the rights and feelings of others.
3. Emotional Regulation. Regulating an emotion means having the emotion be under one’s control – it does not mean suppressing or avoiding the emotion. As a preventative measure, a person can address environmental issues that perpetuate emotional dysregulation, such as sleep habits, taking medications as prescribed, and eliminating mood-altering substances such as alcohol or other drugs from one's diet. During an episode of rapid emotional cycling, a person can practice specific skills such as Opposite Action (e.g., if you are angry and have the urge to verbally or physically attack a loved one, practice the opposite action of walking away or doing something kind or polite for them) to regulate emotions and prevent oneself from reacting in a way that one might later regret.
4. Distress Tolerance Skills. Distress tolerance skills are especially helpful in decreasing symptoms of Borderline Personality Disorder because they build self-esteem, strengthen independence, and foster hope that a person can have a life that is not only emotionally bearable, but is also healthy and desirable. Examples of ways to tolerate distress are holding an ice cube in your fist and observing it melt, practicing Radical Acceptance (accepting, without judgement, the chain of events that led to the present moment), or practicing some form of self-care, such as going for a walk in one of Seattle's many beautiful parks, getting a haircut, or vacuuming your bedroom.
As with any reason a person comes to therapy, it is important to have faith in yourself and keep in mind that at any given time, you are doing the best you can with what you’ve got. Developing insight into how your symptoms express themselves in your daily life and what coping skills are healthiest for you are both excellent first steps to take towards reaching a higher quality of life.