Common Misunderstandings About Borderline Personality Disorder
Borderline Personality Disorder (BPD) is a condition that many people are fascinated by. This, in part, was the result of the thriller, Fatal Attraction, which called attention to the disorder and generated much discussion. Many characteristics of Glenn Close’s character, Alex, are mostly accurate in regards to BPD. Unfortunately, at the same time, those involved with the movie created a character that would function as the antagonist who was responsible for the terror elements in the plot.
This development of the Alex character meant taking liberties with how she was presented, compared to the way BPD actually manifests. In particular, while the unstable nature of the disorder was well depicted, the vulnerability that those with this disorder experience was largely left out, as was her life history that would have shaped the biological predisposition that underlies this disorder.
Borderline Personality Disorder was first described in 1938 by Adolf Stern, who coined the term for a group of patients who displayed emotional instability, impulsivity, over-sensitivity to rejection, and who did not respond well to therapy. He used the term “Borderline” because he felt the condition represented patients who were on the border between neurosis and psychosis but didn’t quite fit either category.
Although these categories have always been poorly defined and unclear with the border between them being even fuzzier, the term Borderline has remained in the name of the disorder. The condition is considered to be a personality disorder since it is pervasive and colors the way the individual views their entire world and those within it.
A Personality Disorder, as defined by the Diagnostic and Statistical Manual, 5th Edition (DSM-5) is “an enduring pattern of inner experience and behavior that deviates markedly from the expectations of the individual’s culture, is pervasive and inflexible, has an onset in adolescence or early adulthood, is stable over time and leads to distress or impairment” (American Psychiatric Association, 2013). It’s important to note that the distress mentioned in the definition may be experienced only by the individual with the disorder, by both the individual and others in their lives or in some cases, only by others the person interacts with.
There are myths and misconceptions related to all of the mental health conditions that exist. These inaccuracies and beliefs need to be corrected as they can lead to stigma and discrimination, a worsening of symptoms and can prevent people who are suffering from seeking help. Borderline Personality Disorder, In particular, has a number of misconceptions associated with it that continue to circulate on and offline, which have led many to a misunderstand the condition.
Debunking Misconceptions About Borderline Personality Disorder
Myth: A person with BPD is just difficult to get along with. It’s not really a disorder.
It is true that most individuals with BPD can seem to be extremely difficult to get along with, unless you are giving them exactly what they need and want in the moment. We all have a learning history and act in ways that have been reinforced in some way.
When we are raised in a healthy environment, usually these ways of acting and interacting with others is adaptive. Yet for some people they are not. For reasons beyond the scope of this article, the ways that people with BPD have learned to act in order to get what they need from others are often perceived of as aversive by those they interact with.
While the causes of BPD are not entirely clear, there is a body of research that indicates that genetics, brain structure and function, and environmental, cultural, and social factors all play a role in its development. One thing that is clear, is that BPD is a very real psychological disorder that causes those who have it a great deal of suffering (Paris, 2018).
Myth: People with BPD are manipulative and controlling.
People often avoid those with BPD since they find them aversive and difficult to get along with. One of the reasons for this is that it is assumed that people with BPD plan how best to manipulate other people to make them behave in certain ways. It is frequently believed that the individual’s unruly, chaotic and inconsistent behavior is intentional.
What most people don’t realize is that those with BPD aren’t acting negatively on purpose. It 's simply the only way they know of to take care of themselves. Their personality disorder makes them rigid and inflexible as to the way they act. This means they don't realize that there are other ways they could behave that would be more adaptive. They stick with what they've learned to do and what they've always done.
Their behavior is aimed preventing what they perceive to be a fate worse than death which is being alone or abandoned. As long as the behavior works in letting them maintain the presence of important people in their life, to them it is perceived of as effective and worth keeping.
Should they believe someone may be preparing to leave them however, they will escalate their behavior to whatever is necessary to keep the person engaged with them. In their minds this is a matter of survival.
The word “manipulation” implies something was thoughtfully planned and maliciously intended. However, more often than not, these behaviors are usually just desperate, last ditch attempts on the part of the person with BPD to get their emotional needs met. They aren’t consciously trying to manipulate or control others.
Myth: BPD is just an extreme form of Bipolar Disorder
These two disorders are actually very different. While the impulsivity and mood swings seen in the two disorders may resemble each other they are not the same. It’s important to remember that personality disorders are pervasive, enduring and effect practically every aspect of a personals life.
In comparison, someone with bipolar disorder who is not in a manic or depressed episode will exhibit stability and able to function normally. Usually, someone with Bipolar Disorder only will cycle on average about once possibly twice a year, so most of the time they are in a stable period.
People with Bipolar Disorder can have good interpersonal relationships that may be disturbed by periods of mania or depression but usually close relationships are not harmed even by periods of illness. The stability you find in between episodes in individuals with Bipolar Disorder is not observed in those with BPD.
Myth: People with BPD are just stubborn and resistant to change. That’s why they don’t get better.
Actually, almost everyone is resistant to change. When we get used to something and it has become familiar we don’t like it to be altered unless the change involves going from something negative to something positive. Even then, though, getting used to something new is an adjustment. All of us have certain things we we are reluctant to let go of.
People with BPD have a system they have relied upon most likely since childhood. While it may cause them distress much of the time, it is what they know. Helping them get to a place where they are willing to change involves showing them what it is like to experience a different kind of relationship with others. This can be done effectively through the therapeutic alliance. It is also necessary to provide them with new ways of getting their needs met before expecting them to give up the strategies they normally use.
Myth: People with BPD don’t care about the people around them. They’re only focused on what they want.
People with BPD have a lot of difficulty regulating their emotions but that doesn’t mean they don’t experience them. When they feel like they can count on others to remain in their life they can be very compassionate and loving. People with BPD care about their friends and family and do feel and express empathy. They also have tremendous capacity to care about pets.
Unfortunately, the problems caused by the personality disorder such as the mood swings, inability to relate to others, impulsive behavior, and unstable self-image are so extreme that they cause problems in relationships. Someone with BPD may not be able to see how their behavior and expectations are affecting those they care about. This may be perceived by others as a lack of caring and empathy.
When they do sense how much distress their behavior causes others that are important to them, they may feel guilty and become depressed. But the various problems they are experiencing, in particular those related to their moods, need for validation and fear of abandonment, may prevent them from acting on their empathy by helping others or expressing the compassion they feel some of the time.
Myth: People with personality disorders are just trying to get attention when they attempt suicide. They don’t really want to die.
There are often times that people with BPD will use self harm as a way of getting attention or stopping something they don’t like. It may also be used as a means of grounding themselves or regulating their emotions. Whereas they may not be able to control the intensity and experience of their emotions, they can control the amount of pain their feel when they engage in self harm.
However, this is a different category of behavior from real suicidal behavior. Those with BPD also engage in self harm with the intent of killing themselves. They may feel that at the moment their agony is too much to tolerate and that suicide is the only way out.
Many people with BPD also have a mood disorder which when combined with their impulsivity and problems with emotional regulation lead to sudden suicidal behavior that is often lethal. As many as 10 percent of those with BPD die by suicide and these cases are almost never the result of accidentally miscalculating the lethality of self injurious behavior.
Regardless of what type of behavior it is, any type of self harm should always be taken seriously and never assumed to be just some type of gesture to gain attention or manipulate a situation. Self harm, even if it’s not with the intent of killing oneself is still harm that needs to be addressed. In BPD there is also a strong correlation between those who engage in non-suicidal self harm and later suicidal behavior. (Sadeh, Londahl-Shaller, Piatigorsky, Fordwood, Stuart, McNiel, D. E., & Yaeger, 2014).
Again, even though all self injurious behavior needs to be addressed, it is important to remember that for those with BPD it often a coping response and has a function. It is important to provide the person with other options and not just take away what is seen as an important component of a person’s ability to function in their day to day life.
Myth: BPD only occurs in women.
There are more women diagnosed with BPD than men. Yet prevalence rates have estimated that at least 30 percent of those receiving a diagnosis are men. It is likely that this is a gross underestimate since the symptoms making up the diagnostic criteria are more likely displayed in women. Men may experience somewhat different symptoms of the disorder.
Men with BPD have been found to be more impulsive, and physically aggressive compared to women with the disorder and to display more narcissistic, antisocial, paranoid and schizotypal characteristics than women. Men are also less likely to display dependent and obsessive compulsive personality traits compared with women (Sher, Rutter, New, Siever & Hazlett, 2019). these differences mean that we may not have an adequate way of evaluating the disorder in men.
Myth: BPD cannot be effectively treated.
This myth can be extremely harmful since it may discourage people from seeking help and result in continued suffering and hopelessness about the future. Like any other disorder, the effectiveness of treatment lies in the skill and training of the therapist and how good a match they are for the person needing treatment.
As with other disorders, until there was enough research and an established empirical base that documented effective methods of treating the disorder, options were limited. Now even those with severe forms of the disorder can significantly improve with the appropriate treatment. Often a combination of medication used for specific symptoms such as anxiety and depression early in treatment and psychotherapy addressing the behavior and causes of the behavior can be an effective approach to treatment.
Myth: People with BPD are dangerous.
This belief was unfortunately reinforced by the movie, “Fatal Attraction”. The truth is that people with BPD are far more likely to hurt themselves than anyone else. They do often exhibit irritability and even rage that is considered inappropriate and inconsistent with the perceived cause. They may have a very short fuse, seem angry much of the time and even get into physical confrontations.
A large 2016 study in the U.K. found that BPD by itself was not significantly associated with violence. However, those with the disorder were more likely to have co-occurring conditions such as antisocial personality disorder and substance abuse which did increase the risk of aggression and violence. A review of the literature resulted in a similar finding, primarily a lack of evidence that having BPD alone increases violence against others (González, Igoumenou, Kallis, & Coid, 2016).
Despite increased discussion world wide about BPD, it continues to be a poorly understood disorder. Individuals with this condition suffer not just from their symptoms but also from the misconceptions, negative beliefs and judgement associated with the disorder. These individuals are often excluded from services and experience prejudice and stigma both in mental health services and the wider society.
It’s important to increase awareness and understanding among the general public and healthcare professionals that the distress experienced by those with BPD is significant and needs to be taken seriously. They deserve compassionate, skillful, effective treatment. It's also crucial for those they interact with to communicate acceptance and avoid rejection based on an incomplete understanding of the disorder. Recovery is possible, as is the ability to experience a positive quality of life which includes healthy relationships. It may take time, but there is definitely hope for a better tomorrow.
American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (DSM-5®). American Psychiatric Pub.
González, R. A., Igoumenou, A., Kallis, C., & Coid, J. W. (2016). Borderline personality disorder and violence in the UK population: categorical and dimensional trait assessment. BMC psychiatry, 16(1), 180.
Paris, J. (2018). Clinical features of borderline personality disorder. Handbook of Personality Disorders: Theory, Research, and Treatment, 2, 419.
Sadeh, N., Londahl-Shaller, E. A., Piatigorsky, A., Fordwood, S., Stuart, B. K., McNiel, D. E., ... & Yaeger, A. M. (2014). Functions of non-suicidal self-injury in adolescents and young adults with Borderline Personality Disorder symptoms. Psychiatry research, 216(2), 217-222.
Sher, L., Rutter, S. B., New, A. S., Siever, L. J., & Hazlett, E. A. (2019). Gender differences and similarities in aggression, suicidal behaviour, and psychiatric comorbidity in borderline personality disorder. Acta Psychiatrica Scandinavica, 139(2), 145-153.
Stern, A. (1938). Psychoanalytic investigation of and therapy in the border line group of neuroses. The Psychoanalytic Quarterly, 7(4), 467-489.
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© 2019 Natalie Frank