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Understanding Borderline Personality Disorder

Borderline Personality Disorder (BPD) often gets a bad rap. Chances are, you have heard this diagnosis (or suspected diagnosis) associated with negative descriptions such as “manipulative” or “difficult.” Unfortunately, individuals who have BPD, along with their loved ones, often misunderstand the condition, leading to increased feelings of shame, blame, and anger. Relationships (social, familial, romantic, etc.) can be hard to begin with, and with the added feature of BPD, it can feel overwhelming to navigate communication and conflict. However, the truth is that BPD is largely misunderstood - both by those with the diagnosis and those around them - and it is these misconceptions that often fuel the invalidation and frustration that plague relationships. The goal of this post is to better explain the features and origins of BPD so that there can be increased compassion and validation for oneself and others. The ways in which this information can be used in practical ways to improve relationships will be explored in a future post.

According to the Diagnostic and Statistical Manual of Mental Disorders (DSM-5-TR), a person meets criteria for BPD if they consistently exhibit any five of the following nine symptoms: fear of abandonment, difficulty maintaining relationships, uncertainty of one’s own identity or sense of self, impulsive harmful behaviors (e.g., substance abuse, reckless spending), self-harm or suicidal thoughts/behaviors, persistent feelings of emptiness, difficulty regulating strong emotions, mood swings, and paranoid thoughts.

Each of these symptoms sounds overwhelming. If you, or someone you care about, struggles with these behaviors or tendencies, you might wonder: Where does this come from? Why would someone be feeling so empty inside, and what would motivate a person to engage in self-destructive behaviors? Let’s dive in.

We’ll start with the name of the condition. A long, long time ago, mental health professionals used the term Borderline Personality Disorder to describe those who appeared to be on the “border” between neurosis and psychosis, as evidenced by their strong emotional reactions and impulsive (often self-harming) behaviors. While the name “borderline” has stuck, that is no longer the intended description of those who receive this diagnosis. In fact, there has been a movement in recent years to relabel the condition “Emotion Dysregulation Disorder,” as we now understand the key feature of the diagnosis to be difficulty with self-regulating mood, rather than the presence of anything even bordering on psychosis.

The true pioneer in understanding, redefining, and treating BPD is Marsha M. Linehan, a psychologist who, herself, has the diagnosis of Borderline Personality Disorder. In the 1970s and 80s, Dr. Linehan sought to understand her own history of strong emotional reactions and feelings of chronic emptiness by meeting with many others who had histories of similar struggles. Her years of research produced a “bio-social” theory of BPD, an explanation that was based on the interaction between a person’s inborn traits and the responses from those around them.

The explanation starts with the premise that certain people are born with heightened senses of emotionality. The same way that some people are born more reactive to light than others, and some are more sensitive to smells or heat, some people are just more prone to emotions. That’s the way they were built. Strong emotional reactivity is not specific to painful or uncomfortable emotions like anger, sadness, and anxiety. People with this “emotional superpower” tend to also have heightened experiences of feelings like love, excitement, and happiness. 

Enhancement of emotions can express itself in terms of frequency, intensity, and duration. Frequency refers to someone’s emotional radar, how often their emotions fire-up. Someone with a high frequency of emotions might be emotionally reactive to events that others would not be. This person might be hypersensitive to perceived criticism or become deeply attached to someone they just met. Intensity describes the strength of feelings. In addition to their emotions being “triggered” more easily, these individuals’ feelings are also more intense than the feelings of others. Their happiness is absolutely exhilarating and their sadness may feel like crushing devastation. Put another way: their highs are higher and their lows are lower. Duration describes how long the emotions last. On top of being more reactive and feeling stronger emotions, these individuals often take longer than others to “come down” from these highs and “snap out of” these lows. To sum it up, those born with increased emotionality tend to experience emotions more often, more strongly, and for longer periods of time than those around them. 

By itself, this biological enhancement of emotions is not necessarily a problem. Some people were just born to feel more than others do. The problem comes when we consider how such a person is likely treated by those around them, starting from a very young age. When a young child exhibits strong emotions, their parents, peers, teachers, etc. are quite confused. They are not used to seeing such heightened frequencies, intensities, and durations of emotions. Such sensitive, strong, and prolonged emotional reactions can be painful or disruptive to those in the child’s environment. Therefore, it is likely that the child’s emotions will be met with dismissive or repressive responses including, “Stop being such a baby,” or “You’re being so dramatic,” or “Why don’t you get over it already?” 

Often unwittingly, the message conveyed by the environment to an emotionally sensitive person is: Your emotions are wrong; you should not be feeling this way. Over time, the child begins to internalize the persistent invalidation, leading to questions about one’s own identity, and a gaping hole inside as they learn from others not to trust their own sense of emotional reality. As strong feelings continue to receive chronic invalidation, the individual may learn to suppress or blunt their unwanted emotions through substance use or dissociation.

Alternatively, they may engage in intense or risky behaviors which externalize and match - and therefore validate - the intense pain they are feeling inside.

To sum it up, the bio-social theory of BPD is that a mismatch between a person’s biological temperament and their social environment leads to a chronic sense of invalidation - both from others and from themselves. This may be part of the “empty” and “unreal” feeling that individuals with BPD often struggle to articulate and those around them struggle to comprehend. Further, when a person has learned to feel exclusively in degrees of “nothing” or “too much,” it is understandable that they will struggle with emotion regulation and impulse control. These, naturally, are likely to lead to high emotional volatility in their adult relationships, and intense fears of abandonment that stem from deep-rooted (often unintended) invalidation from their loved ones.

Based on this re-conceptualization of Borderline Personality Disorder (AKA Emotion Dysregulation Disorder), Marsha Linehan developed a treatment to address all of these symptoms: Dialectical Behavior Therapy (DBT), which has become the gold standard in treating BPD over the last 30 years. Through various skills and strategies, DBT can help people learn to validate themselves and others, regulate their emotions without shutting them down, and communicate more effectively. 

As mentioned, some practical tools and suggestions for addressing the impact of BPD in relationships will be explored in a future post. For the present entry, simply having a better understanding of what BPD is really all about, and showing compassion to oneself and others, can be a very validating first step.


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