BY VAALPARK MHU | July 7, 2021

Blog By

Dr Melané van Zyl
Psychiatrist

Borderline Personality Disorder (BPD) is a common psychiatric disorder, with 6% of people meeting the criteria in their lifetime.

We all know someone with it, or we have traits of it ourselves.

People who meet the criteria for the full diagnosis suffer intensely, and they cause a lot of suffering to those around them, often unwittingly and unconsciously. However, patients do not commonly come to seek help because they have diagnosed themselves with it.

BPD causes many symptoms, which includes:

  • mood swings
  • impulsivity
  • depression
  • suicidal ideation, and
  • relationship problems

There often are trauma experiences in childhood, and almost any thinkable symptom can occur and cause problems such as panic attacks, poor concentration, and excessive anger.

What is Borderline Personality Disorder?

With an ever-increasing amount of information on the internet and interaction on social media, some (especially millennials and Generation Z’s) have often stumbled across the name and find the symptoms familiar. It should be noted that the diagnosis of BPD can only be made by a psychiatrist or clinical psychologist, so do not diagnose yourself (or your boss).

Main Cause of Borderline Personality Disorder

There is no single cause of BPD, but it includes genetics, problems with brain development and environmental factors (being a victim of emotional, physical or sexual abuses, being neglected by one or both parents).

How is Borderline Personality Disorder diagnosed?

There is no specific test to make the diagnosis. Psychiatrists and psychologists use the DSM V diagnostic criteria.

According to the DSM V BPD is diagnosed as follows:

BPD is a long-standing pattern of symptoms and behaviours, not an episode. It starts in the teenage years, but we only diagnose it from the age of 18. The main problems occur with regards to relationships, self- image (low self-esteem and being unsure about aspects of the identity) and mood swings, as well as being impulsive (acting before thinking things through).

  • Chronic feelings of emptiness

Emptiness means not necessarily feeling depressed but feeling nothing. This is often unbearable.

  • Emotional instability in reaction to day-to-day events (e.g., intense episodic sadness, irritability, or anxiety usually lasting a few hours and only rarely more than a few days)

Emotions are very unstable; mood swings occur throughout the day. The mood is “reactive”, meaning the mood are triggered by the smallest of problems.

  • Frantic efforts to avoid real or imagined abandonment

People suffering from BPD are petrified of being rejected, or those close to them leaving. They are often charming and popular because they want to be liked. Deep down they believe they are going to be rejected sooner or later, and when the anticipation of the breakup becomes too much, they will even start a fight, then they can say “See I was right, I said you were going to leave me”.

  • Identity disturbance with markedly or persistently unstable self-image or sense of self

There is a chronic low self-esteem and uncertainty about who they really are. This can present as uncertainty about their sexual orientations, or their value systems. They do not have a strong sense of who they really are, so if they meet someone they really like, they will develop the same habits, look, beliefs etc. as that person.

  • Impulsive behaviour in at least two areas that are potentially self-damaging (e.g., spending, sex, substance abuse, reckless driving, binge eating)

I think this one is quite clear.

  • Inappropriate, intense anger or difficulty controlling anger (e.g., frequent displays of temper, constant anger, recurrent physical fights. 

This one as well.

  • Pattern of unstable and intense interpersonal relationships characterized by extremes between idealization and devaluation (also known as “splitting”)

When first meeting someone with BPD, he/she often makes you feel like you are the best thing ever to have happened to him/her. You are the first one that has ever understood, you are a wonderful person, and you are placed on a pedestal. This can be flattering and even irresistible. However, no one is perfect, and you cannot continuously meet the expectations that are put on you. The fact that you are failing makes the person with BPD angry, and you are pushed off the pedestal. There is interesting and complicated psychology behind this behaviour, but in a nutshell BPD dynamic lead to an inability to understand that all of us have good and bad qualities. They see people as all good or all bad- and this view can change in an instant.

  • Recurrent suicidal behaviour, gestures, or threats, or self-harming behaviour

Not all people with BPD cut themselves or overdose regularly, but this is a well described pattern. Again, there is interesting dynamics at play that explains why this happens. Often the feelings of emptiness become too much, or it is a way of self-punishment or self-regulation. 10% of people with BPD commit suicide successfully.

  • Transient, stress-related paranoid ideation or severe dissociative symptoms

People with BPD are extremely sensitive and take things personally, sometimes to the extent that they appear suspicious and paranoid. They also do not trust others and read more than what they probably should into other’s actions. They are often not comfortable in their bodies and can even hate their bodies (due to trauma in the past that involved the body). This causes them to feel not “in” their bodies, or to symptoms such as dizziness, numbness, and pain.

Are people with BPD aware of their Behaviour?

Yes, and intensely and painfully so. But they do not know why they behave like they do, and they feel unable to control their behaviour. Behaving irrationally and impulsively leads to painful consequences, which creates a vicious circle that feeds into their already low self-esteem.

Treatment for BPD

The treatment for BPD can be challenging and it is a long journey, but it is incredibly satisfying to eventually be able to be rid of the diagnosis (and of course, the suffering). Sometimes medication is used, but usually specific psychotherapeutic techniques like DBT (Dialectical Behaviour Therapy) is more effective.

Dr. Melane Van Zyl