Understanding Borderline Personality Disorder (BPD)

There is a true tragic health issue in this country. It affects 2% of the population in general. To put this in numerical numbers that might impact you more, that equates to a little over six million Americans (though some figures put this number at nearly ten million). That's a "6" followed by six zeros! And there are doctors (medical, psychiatric and therapy) out there that are finding it hard to believe the diagnosis exists; despite the fact that it has been studied, written about and treated since 1989. It affects primarily females (75% of diagnosed patients). We are talking mothers, sisters, wives and daughters here. And begins as early as pre-teen through mid-life.

What is this health concern? Its called Borderline Personality Disorder (BPD for short). It used to be used as a catch-all diagnosis when doctors couldn't determine (or couldn't bother to determine) a psychiatric illness. It was used to include everything from self image issues to bipolar disorders to depression. And though these disorders are part of the Borderline's symptomatology, they are more intense and the treatment regime is different.

The National Institute of Mental Health (NIMH) categorizes Borderline Personality Disorder (BPD) as "a serious mental illness characterized by pervasive instability in moods, interpersonal relationships, self-image, and behavior." (NIH Publication No. 01-4928) The DSM-IV (Diagnostic and Statistical Manual of Mental Disorders - 4th Edition), which is a comprehensive classification of officially recognized psychiatric disorders, states BPD is "a pervasive pattern of instability of interpersonal relationships, self-image" and is noted by a "marked impulsivity beginning by early adulthood and present in a variety of contexts," "frantic efforts to avoid real or imagined abandonment," and a "pattern of unstable and intense interpersonal relationships characterized by alternating between extremes of idealization and devaluation."

To put this in terms that may be more recognizable to the lay person, here are some examples of what the professionals are saying in their doctor speak.

Instability in moods
A person with BPD has intense moods swings that can last anywhere from a few hours to maybe a day at most, as opposed to someone with bipolar, or manic depressive, disorder where symptoms swings last longer. They might be happy when they wake up, then angry when you see them later and then painfully depressed by evening. Now that is not to say this is how it always is, but in the more intense phases of this illness, these swings can be so pronounced the person's reactions might make you think they are schizophrenic.

Unstable and intense interpersonal relationships
In a relationship, someone with BPD will alternately idealize and devalue the other person. They may feel this person loves them completely and utterly; then they will believe the person hates them, puts them down and will leave them. They may even see the other person as someone who is undeserving of them. This issue hearkens to the abandonment issues most all Borderlines face. And they will often get into, and remain in, dangerous or destructive relationships. Or they will destroy a relationship before the other person has a chance to leave them.

Instability in self image
A Borderline will often cut themselves (self-mutilation) or have an eating disorder because their image of self is so warped they cannot think of themselves as attractive or worthwhile in their current state. The eating disorder is a way of controlling how they look because they believe themselves imperfect. The cutting can be the result of factors such as image or pain manipulation.

Avoidance of abandonment
The suffer from this illness will truly believe they are not worthy enough to be around, that they are "bad" in some way. They will be angry if someone is a few minutes late or has to cancel an appointment due to unforeseen delays. They might feel a keen sense of despair when their psychiatrist says the session is up. They may feel intense fear or inappropriate anger about a change in plans. Often, a person with this disorder will push their partners, family and friends away, thus causing a self fulfillment of this belief. Their need to avoid abandonment may lead to self-mutilation or a para-suicidal episode.

Marked impulsivity
Impulse control in a person with BPD is extremely weak. They will have some or all of the following issues. They will engage in unsafe sexual activities. They will abuse drugs and/or alcohol. They may spend way too much, too quickly. Or they might drive recklessly again and again, despite the possible reprisals by the law. The person with BPD may have difficulty controlling anger. Or they may experience periods of feeling removed from reality. They will often act and react intensely to any given situation without regard to consequences. This often leads to a Borderline putting themselves in dangerous situations. It may also lead to the abandonment issues again by pushing away family and friends.

The tragedy of this illness is the public perception of both the person and the disorder. Most people simply do not know that this disorder exists. And what they view in people who suffer from it, makes them either dismiss or condemn. People will even often define the person by the illness, which merely reinforces the sufferer's view of themselves. It is not unusual to hear from someone that a young woman with BPD is just "trying to gain sympathy", or is "just spoiled and wants the attention." I've even heard said that an adult who is suffering from BPD is just "using" their parents or loved ones who are actively offering a support network. People dismiss or condemn what they don't understand. And the sufferer grows in their isolation from the world.

The statistical data (from Borderline Personality Disorders Resource Center, among others) about Borderline Personality Disorder reports that 6 to 10 million Americans are diagnosed with BPD. This number represents 2% of the general populace. 10% of all mental health outpatients suffer from it. And 20% of all psychiatric inpatients are diagnosed with this disorder. Studies by the NIMH show that "many, but not all, individuals with BPD report a history of abuse, neglect, or separation as young children." And 40 - 71% of BPD patients report "having been sexually abused, usually by a non-caregiver." These studies, and others like them have led researchers to believe that BPD results "from a combination of individual vulnerability to environmental stress, neglect or abuse as young children, and a series of events that trigger the onset of the disorder as young adults". The inability of adults with BPD to keep themselves out of harmful environments, their impulsivity and their poor judgment in choosing partners and/or lifestyles, often result in them more likely to become "the victim of violence, including rape and other crimes."

And these are just the "diagnosed" cases of Borderline Personality Disorder. It is common for misdiagnoses to occur. I know of one young woman who was consistently misdiagnosed for eight years, mainly due to the medical profession's lack of acceptance of this disorder. That was eight years of suffering, eight years of prescription experimentations, eight years of her young life missed because of ignorance and/or faulty perceptions. And in all that time, her isolation from other in the general public who did not understand to criticize and condemn her.

Understanding that this disorder is real and causes the person suffering from it great stress and pain is half the battle. If the public starts to understand this disorder, then the politicians who vote on health care, the insurance companies who regulate our lives in the medical arena and health care providers themselves will follow. There is help. There is treatment. There are medications to control the symptomatology. There are books out there to help understand. (One such highly recommended book is "Stop Walking On Eggshells" by Paul T. Mason ISBN: 157224108X) There is no cure. Living with this disorder is difficult on the sufferer, their family and their friends.

If you know of anyone who seems to be reflected in this article, it is important to do two things. Don't judge. And see professional advice. A great resource is the Borderline Personality Disorder Today website. Here you can find support, advice and even health care providers who treat BPD.

Be safe. Be well. And be considerate.

Reference Sources
NIH Publication No. 01-4928
http://www.nimh.nih.gov/health/publications/borderline-personality-disorder.shtml

Borderline Personality Disorders Resource Center
http://www.bpdresourcecenter.org/what_facts.htm

CIA POPULATION REFERENCE
https://www.cia.gov/library/publications/the-world-factbook/print/us.html

DSM-IV (Diagnostic and Statistical Manual of Mental Disorders DSM-IV (4th ed))
by American Psychiatric Association
(ISBN-10: 0890420610)