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.