BPD is one of the most misunderstood and stigmatized mental health conditions.
I was initially drawn to working with individuals with BPD while in graduate school. As I learned more about psychopathology, I was confused by the stigma and judgment surrounding the BPD diagnosis. I became curious (and frankly frustrated) when I realized that many medical providers were avoiding and sometimes outright refusing to treat a whole clinical population in dire need of support. What really hooked me, though, was discovering one of the most devastating ironies of BPD: more than anything, individuals with BPD want to have meaningful connections with others - and this is the very thing which often evades them due to untreated symptoms.
One of my goals as a mental health practitioner is to demystify the presentation of BPD symptoms so that individuals (and loved ones of individuals) struggling with the disorder 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.
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