Q: What’s your take on Borderline Personality Disorder (BPD)? I ask because the newly committed H.R. 1005 would create a “BPD Awareness Month” (May, I believe) during which, apparently, the public would be educated about BPD by the federal government in a manner deemed fitting by Congress. As an acute propagandophobic, I’m already starting to break out in hives. Some straight talk from the IS could be just what the doctor ordered. – Fuzzy
Dear Fuzzy,
Given the timing with which this story presented itself, I suspected an April Fool’s Day joke. But by all appearances, BPD Awareness Month appears to be legit.
Here’s the problem, as I see it. According to the Federal Government, May is the month during which we are to become aware of better sleep, clean air, vision, lupus, mental health, physical fitness, teen pregnancy, food allergies, stuttering, recreational water illness, and 24 other health topics.
Do we really have room for one more awareness? Just how aware do these bureaucrats think we can be? We’re only human, for God’s sake! In the interest of simplicity, I am declaring the month of May to be Awareness Awareness Month here at Ironshrink.com. That’s the kind of cut-to-the-chase thinking that we should be demanding from government.
Let us begin our Celebration of Awareness with a heaping helping of Borderline Personality Disorder. To answer your question Fuzzy, I believe BPD is a legitimate diagnosis. It is a miserable condition for those who suffer from it, and it can be just as miserable for those who must live with them. Chances are, you know somebody who fits the description.
Happy Borderline Personality Disorder Awareness Month
I tend to disapprove when the government spends our hard-earned greenbacks on symbolism, and what is a Congressman’s “awareness” resolution if not symbolic. But in this case, I don’t mind dropping a few bucks to spread the word about BPD. This condition brings misery to those who suffer from it, and it can be equally painful for the people in their lives. Few people who encounter BPD realize what they’re up against. They just know that something is terribly wrong.
BPD, as defined by the APA (2000), is a pervasive pattern of unstable relationships, self-image, and emotions that affects roughly 2% of the population.
BPD is one of ten personality disorders recognized by the APA, including…
- Paranoid Personality Disorder: Think of the more paranoid features of Saddam Hussein’s personality: distrustful and grudge-bearing, he read hidden threats into benign situations, and he was suspicious that others were out to get him. (Turns out he was right.)
- Antisocial Personality Disorder: Tony Soprano seems to fit this diagnosis: charming, calculating, reckless, deceitful, and able to harm others without remorse.
- Narcissistic Personality Disorder: Think of Steve Carell’s character, Michael Scott from The Office: inflated sense of self-importance, lacking in empathy, envious of others and believes that others are envious of him.
- Avoidant Personality Disorder: Pick a Woody Allen character. This person avoids interpersonal contact that might result in criticism, disapproval, or rejection.
- Histrionic Personality Disorder: The existence of this one is still up for debate among many shrinks, but a fair example is Bill Murray’s character in What About Bob. He was compelled to be the center of attention, he had rapidly shifting and shallow emotions, he was theatrical, and he considered relationships to be more intimate than they were.
You’ll note that none of those people are known for their ability to play well with others, and I wouldn’t want to be married to any of them. That inability to get along with others is the hallmark of personality disorders. BPD is perhaps the most painful of the lot for both the sufferer and the people in his or her life.
Perhaps the most famous fictional example of BPD is Glenn Close’s character in Fatal Attraction. One minute, Michael Douglass was a prince to her; the next minute she wanted him dead. Her behavior was exaggerated and theatrical, but people who live and work with BPD sufferers often report a similar experience: one minute you’re a saint, the next minute you’re the devil.
Some of the more important markers of BPD, according to APA (2000), include:
- Frantic efforts to avoid real or imagined abandonment: BPD sufferers tend to live in fear that they will be dumped by the people in their lives. The very thought of being abandoned can lead to powerful thoughts of being fundamentally damaged and unworthy of love. Thoughts of abandonment, whether real or not, can be met with extreme anger aimed at unsuspecting friends, family, or lovers. Efforts to avoid abandonment can include reckless and impulsive acts including suicidal behavior.
- A pattern of unstable and intense relationships in which the BPD sufferer alternately idolizes and devalues others: A person can go from saint to devil, and back again, repeatedly. One minute you’re the target of affection; the next minute you might be dodging flying objects. Obviously, this can be a disorienting experience for all concerned.
- Potentially self-damaging impulsivity: I’m sure that most of us, at some point or another, would like to overindulge in activities such as sex, eating, substance abuse, and reckless driving. For the person suffering BPD, such impulsive acts can become a narcotic that numbs feelings of low-self worth and abandonment.
- Chronic feelings of emptiness: Just as they tend to see others as all-good or all-bad, BPD sufferers have difficulty seeing themselves as whole individuals with coexisting positive and negative qualities. They tend to judge themselves harshly based on their most recent achievements. Unfortunately, they tend to undermine themselves just prior to success.
In the book Stop Walking On Eggshells, Mason and Kreger succinctly and accurately sum up the inner experience of BPD:
“People who suffer from it desperately want closeness and intimacy. But the things they do to get it often drive people away from them.”
I couldn’t have said it better.
Are we aware yet?
The reason I’m not opposed to a few government dollars devoted to BPD Awareness Month is that few people are… um… aware of the disorder. That leads to an undue amount of suffering on both sides of the BPD equation. There is effective treatment for BPD, but only if the sufferers or the people in their lives know enough to seek it out.
As to whether BPD Awareness Month will actually translate into increased numbers of treatments, a 2003 study on a cancer awareness campaign indicated that it did, in fact, correspond with an increase in search-engine activity related to cancer screening.
Eh, that’s good enough for me. My passions don’t run deep on either side of the “awareness” trend of recent years, but treatment for BPD is certainly in need of some good PR.
As Mason and Kreger point out, BPD is an unflattering condition and so we are unlikely to see a glitzy celebrity draw attention to the cause by proclaiming his borderline status to the world. We wouldn’t have to look far to find a few celebs who fit the symptoms, but let’s face it: treatment for BPD will never enjoy the fame and glamour of celebrity drug rehab and colonoscopies.
-IS
References
American Psychiatric Association: Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Text Revision. Washington, DC, American Psychiatric Association, 2000.
Cooper, C.P., Mallon, K.P., Leadbetter, S. et al. (2003). Cancer internet search activity on a major search engine, United States 2001-2003. Journal of Medical Internet Research, 7(3).
Mason, P.T. & Kreger, R. (1998). Stop Walking on Eggshells: Taking Your Life Back When Someone You Know Has Borderline Personality Disorder. Oakland, CA: New Harbinger.
Thanks for the info. I have been told I have BPD. Of course, when I get a new psycho they just can’t believe I could have this disorder….I don’t seem to have the symptoms (haha, fooled another one). I have 2 daughters, a year apart. 17 & 16. My 17-year-old daughter has the same symptoms, i.e., anxiety, suicidal thoughts, etc. My 16-year-old does not. Both girls have been raised the same. I totally believe that genes play a much higher role then the 58% believed for having BPD. Do people with BPD get anything free for BPD Awareness Month? If so, count me in. Anyway, thanks for the information on other types of personality disorders.
i totally agree with what you said about the genes, i mean, i am 16 and diegnosed with BPD. i have 2 brothers and 2 sisters all of which dont have BPD nither do my parents, or my grandparents, or my great grandparents… my Aunt many times removed is the only other known person in my family to be diegnosed with it. and what makes it even worse is, my parents dont understand why i act the way i do or say the things i do, as for a matter of fact i dont always know why or what im saying untill its too late, so i agree with awereness month and i hope people will soon better understand what we are going through.
“Haha, fooled another one” lmao, been there done that… not helpful in the long run but sooo easy to do.
Bring it on, I was originally diagnosed with BPD in October 2009. Since then my diagnosis has expanded to include the whole cluster B type personality range. I’m nearly 22 now, and honestly, more education about mental illness generally would have made my life and the people around me’s lives much much easier.
Seryph – you’re still young. Don’t take these Axis II diagnoses to be a life sentence.
It is emotionally, physically draining to be involved with such a person. Married 10yrs and wife left matrimonial home 3 times in 2002 for 8mnth, 2005 for 8mnths now 2010 for 11months. She left kids of 7 & 8 with me. Previous two occassions I did not know reason, now it is affair with a coworker who is a family friend. She hardly touches on subject when she yells at me, phones me early hrs of the morning, calling me monster, evil, you name it. Before she left, I remember her telling me my mother was evil, I am poor, son of a helper. It is true but I managed to get tertiary education, buy her a car, a house, vacations and kids at private school. No appreciation whatsoever. Now that I know the name of the affliction, I am a bit relieved. My problem is I wish she could find solution as we are told we are not to act as their therapists. She is a high functioning, sweet, good career and no one will believe me. I think her family knows her condition as no one ever intervenes when she acts irrationally by abandoning home. In 2005, I filed for divorce, we were discussiong settlement when she requested second chance and I gave in. 2010, she filed within two weeks of her leaving home. She stopped and I filed. We already went to Family Advocate as we battling for custody. Sometimes she would just congratulate me when my favourite team has won a cup. Then we won again within a week and I reminded her to do likewise, not in a nasty manner and I did regret as I was told where to get off.
She is a recent born again, teaches Sunday School. Her behaviour has tested my faith as I had asked God for a good wife/marriage but this. I am no Saint but mostly my reaction was due to her condition which then I did not know but thought of as ego, pride etc. I go for counselling but it is consuming me.
Is BPD real??
She is not remorseful or repentant about the affair. Actually, she behaves like she does not know why we are divorcing. Sees me as evil, disappointed kids by my evil behaviour, a monster etc.
Curious, can one be misdiagnosed with BPD and/or be “cured” from it? I heard there wasn’t a real cure but I know someone that was diagnosed with it but seems to have overcome it now. What do you think?
Hi Anonymous, in my experience, overcoming BPD is really a matter of learning new skills. It takes a lot of work, but it is definitely possible to overcome this problem.
Anonymous,
I don’t know if you’re still following, but Dr. Marsha Linehan of UW has done some amazing work around BPD. Please do some exploration of DBD (Dialectical Behavior Theory). Dr. Linehan developed this theory and has used it to effectively treat many people with BPD (including herself). There is group and individual work involved, but as Shawn suggests, it is definitely possible to overcome the problem as you learn ways to recognize the cycle and cope effectively. I wish you the best.
My typo: that’s DBT, not DBD!
A few questions or thoughts or just thinking ‘out loud’ in print. In reviewing what I’ve written I find I have written you a novella. I’m trying to puzzle it out, and while I’d love feedback I would understand if this is too long and wandering to reply to.
Do you think BPD can be induced by substance abuse? Or at least greatly magnified? Can a person with BPD learn to manage it on their own for the most part and then lose that ability to cope?
I’m married to someone who is, or was for close to a decade, a closet addict. High functioning, never had legal issues, a nice social circle of nonaddicted friends, meaningful hobbies, good job with regular promotions and raises, two kids, a house, two dogs, and no debt issues.
I’m struggling to understand how the addict part got in there. It wasn’t always there, it began in the mid thirties. Always there would be easier to understand for me.
One thing that makes me wonder about BPD is that last last sentence under “chronic feeling of emptiness”- tends to undermine themselves just prior to success. In one way that is a fantastic description of ‘the recovery process’ I’ve been witnessing/experiencing for the last eighteen months. As soon as things seem to be going well and he has a few months clean he implodes. If he relapsed when things were going poorly it would be far less frustrating.
But on a bigger level, in one way, the entire addiction looks like this. Like many couples our early years were marked by almost constant struggle; interfering first husband, financial stress, employment concerns, and the stress of having two babies/toddlers and a sick child. Then life settled down. The ex dropped off the map, the job situation was worked out, the finances improved greatly, the sick child improved, and the kids were both in elementary school. So just as all that struggle and hard work started to pay off, he dove into a prescription narcotic addiction.
The timing kills me. We struggled as a young couple but we were also happy. I wondered for a time if the sense of struggling together was important, and he grew distant when things settled down because of this. I know now the distance I sensed was caused by the numbing effects of using drugs along with the need for distance to hide from me his use. But the question of why, why the need to abuse drugs and why at that point in time haunts me.
Thinking about it in terms of undermining the self just when things start to look good makes some sense to me. It makes perfect sense in terms of relapse. He judges himself harshly for having been addicted, so when things are going well it triggers shame and undermining himself, making things go less well, relieves him of the feeling of being undeserving, of the feeling of shame. That makes sense but is this an indication of BPD or just part of the experience of being a recovering addict?
It is harder for me to see the fit in regard to the initial descent into addiction. While what I am seeing now seems like a close fit for BPD, switching between viewing me as a perfect angelic being and a spiteful cruel witch, lots of black and white thinking in general, responding to imagined threats of abandonment (I have no intention of giving up on him but he can not grasp this fact) in ways that are counterproductive (anger or threats of self harm or isolating), a destroyed sense of self worth, a feeling of not knowing who he is, and of course the addicted behavior itself, these all seem to fit BPD. Then again there is the paranoia and obsessive self focus which seem like they fit other PD’s…
I’m just wondering which is the cart and which is the horse. Did some level of BPD contribute to his becoming addicted, or did the addiction that he so carefully hid from every other living soul for close to a decade and the shame, fear, and guilt of coming out of the closet and struggling (with frequent set backs) to get clean and restore our relationship (also with frequent set backs) contribute to him now having the BPD traits? Or is it both, a vicious cycle? The thing is, I don’t see the fit with BPD traits prior to the addiction.
He did not have impulse control problems for the first decade of our relationship. He was able to have a stable relationship. He seemed to view me as a whole person, neither an angel nor a villain. Just a regular mortal girl. He drank and used recreational drugs with moderation and thoughtfulness to time and place. He was or seemed emotionally stable (at least as much as the next guy, I think everyone has moments of instability at times), he didn’t show excessive anger or self pity. He pursued his goals and hobbies, dealt with set backs philosophically and when things went wrong he was able to take meaningful corrective action. He did not undermine his successes, he got and kept a good job, he pursued his education, he managed to stay out of debt, he went after and succeeded in getting a number of promotions at work. He was not overly jealous or controlling, nor was he at the other end of the spectrum, in his relationship with me. Which is an awkward way of saying he didn’t seem to overly fear my leaving nor did he act in ways that pushed me away.
Out of all the descriptions of BPD traits the only one I saw in the first decade of our relationship to a notable degree (As I said above, I feel like most humans exhibit those traits sometimes. For example: I think everyone has some level of fear of abandonment and can initially react counterproductively to a real or perceived threat. It seems to me the difference is one of degree and the ability to recognize what we are doing and take corrective actions.) (Sorry about the excessive asides, I have a somewhat peculiar writing style.) (also, I might sometimes directly address the reader. Although the convention of not doing so seems to be rapidly dying. A shame really, even if I’ve directly contributed.) Where was I? Of all the BPD traits mentioned above the only one that stood out in the first decade of our relationship was a tendency to be very harsh with his self judgements. However he did not cling to those self judgements, he seemed able to see past them given some time.
So I’m back to where I started. Did the closet addiction trigger BPD traits? Are these traits just a phase in addiction recovery? Or does the fact that he looks to have these BPD traits now indicate maybe they were always there and the process of coming out of the closet coupled with the damage addiction does to the sense of self has just magnified them?
In many ways it does not matter. He is surely behaving like someone with BPD these days, so learning how to best cope with those traits in a loved one makes sense to me. There is, however, still my puzzle. Why turn away from your loved ones and abuse drugs at all, and why then. He claims to have no answer to that question. Not knowing is uncomfortable for me, but not intolerable. Sometimes not knowing is a gift, since thinking you know what you do not know prevents learning and growth. In this case, though, the not knowing causes me fear. Fear that whatever began the cycle could reassert itself at some point in the future. Where is the line between there are no guarantees in life and taking reasonable precautions?
And I feel sure I’ll find the answer to this question as I read more about BPD but I need to ask, can having a loved one with BPD make you feel like you might have BPD too? His switching between seeing me as perfect and accusing me of being the devil can make me obsess on the possibility that he will abandon me, and sometimes I react in anger to that switching. The repeated disappointments as he manages to take two steps backward for every three steps forward sometimes makes me feel hopeless enough to want to blow the whole thing up and get it over with. I wonder if staying with an addict that repeatedly drops out of recovery and relapses might boarder on self-destructive. I find myself disturbingly emotionally reactive, and even though I recognize this makes things worse, I can not always manage my reactions appropriately. In many ways I feel like I’m an emotional teenager these days, and it isn’t much fun.
Hi Notthereyet,
Wow, sounds like you were put through the wringer. Just a couple of quick thoughts. Yes, I’ve noticed that addiction can mimic BPD symptoms, and I suppose in many cases that’s a question of reduced coping skills. We’re simply not at our strongest or most rational when fighting a substance. And yes, I’ve noticed that people in intimate relationships sometimes find themselves behaving with some of the same BPD symptoms. For example, intimate partners with BPD often dislike their partner’s friends and family because they are seen as a threat, so in order to maintain the relationship and keep the peace, the non-BPD partner may start adopting some BPD approaches to their friends and family. When the relationship with the BPD partner ends, the non-BPD partner may find him or herself going back and repairing ruptured relationships with friends and family.
Good luck to you in piecing things back together. Sounds like you’re off to a great start, and I hope your ex does well also.
Shawn
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I have to say that I’m shocked and saddened by this blog post. BPD = misery? Is that really the equation that you’re presenting here, shrink? Your ramblings are nothing more than diluted psycho-babble at best, and worse if someone actually listens to you. People with BPD are more than capable of living out ‘normal’ lives. Does it take work? Of course, but I’d love to here about a life (or a relationship of any kind) that didn’t require work. What proves that you have absolutely no idea what you’re talking about is your comparison of BPD to ‘Fatal Attraction’ … really? That is an idiotic and judgemental statement, and it’s statements like that one that promotes stigma – which is why we need an awareness month, by the way! Furthermore, you failed to mention therapy programs like Dialetical Behavioral Therapy (DBT), and the positive results that it’s having on the BPD community, or did you not bother to research that when you typed Borderline Personality Disorder into Google? If you’re going to post about BPD awareness, and the description of those who have it, and live with it, then get your information straight, and remember that your words *do* effect people!
Hi Cherrygirl. Diluted (deluded?) psycho-babble ramblings? That seems like a strong response. First, let me say that this post is four years old and I would rewrite each of the old ones if I had the time. That said, yes, BPD is miserable. It is miserable for the person who suffers from it undiagnosed, and it is miserable for the people around them. You’ll note that this post was about awareness of BPD. Awareness and proper diagnosis are crucial. Based on the pain and suffering in people I’ve met who didn’t understand where their problems were coming from, “misery” is not too strong a word for untreated BPD.
I certainly agree with you that every life involves some struggle, and BPD is treatable. And you are of course correct that people with BPD can lead healthy lives with good relationships. Marsha Linehan comes to mind. Treatment involves a lot of hard work, but I have seen people succeed. You might check out my related post, which addresses DBT, here:
http://ironshrink.com/2008/06/does-dialectical-behavior-therapy-really-cure-borderline-personality-disorder/
And no, I don’t think that Glenn Close in Fatal Attraction was an accurate depiction of BPD, which is why I described it above as “exaggerated and theatrical.” Read it again if you missed that. I would never mock someone struggling with a problem. I cited “Fatal Attraction” because it is a vehicle most people recognize, and it illustrates splitting, which is one of the main symptoms of BPD. Sorry if I stepped on your toes. My intent was to the contrary.