Living with Borderline Personality Disorder
It’s estimated that about 1.6% of people in the general population have borderline personality disorder (BPD), though this number skews much higher in psychiatric settings. BPD is a complex and often misunderstood diagnosis. Symptoms of BPD can be caused and/or exacerbated by many other mental health conditions, including substance use disorders, bipolar disorder, PTSD, and other personality disorders.
In addition, the concept of self-diagnosing can be controversial. While it’s helpful to develop insight into your concerning symptoms, many people can and do misdiagnose themselves. Many factors play into establishing an accurate diagnosis, and various symptoms overlap with other ones. That said, quality treatment isn’t always accessible (or straightforward), and having an idea of a potential diagnosis can be the first step toward seeking help or improving how you feel.
Main Symptoms of BPD
In the DSM, BPD is listed as a Cluster B disorder characterized by sensitivity to rejection, patterns of unstable relationships, distorted self-image, and impulsive behavior. BPD affects self-esteem and relationships, and it can also impact employment, finances, and physical health.
It’s important to note that all personality disorders exist on a spectrum. People with milder conditions may feel like they can function relatively well despite their symptoms. To contrast, those with more moderate or severe presentations may feel debilitated. A combination of genetics, environment, and natural disposition can impact the severity of any mental illness.
While BPD symptoms often first emerge during adolescence, it’s common for people to be diagnosed in early adulthood. That said, it’s important to rule out other physical and mental health comorbidities.
Intense Fears of Abandonment and Efforts to Avoid Abandonment
The hallmark feature of BPD is the fear of abandonment. People with BPD generally have histories of childhood abuse that resulted in real or perceived abandonment. From a young age, they developed a core fear that people would ultimately reject and hurt them.
This fear often acts as the motor driving their relationships. In a desire to avoid abandonment, some people with BPD jump into intimate relationships much too quickly. They trust easily and might assume they’re closer to people than they really are.
At the same time, someone with BPD might also be quick to end things rapidly. This often happens in response to sensing rejection. Unfortunately, this cycle can perpetuate even more feelings of abandonment. That’s because there is a limited ability to form genuine closeness with others.
Intense and Unstable Relationships
People with BPD often have a history of highly-charged relationships with others. This intensity is often present in numerous types of relationships, including those with friends, family members, and romantic partners.
In such relationships, it’s common to experience overidealizing, which refers to inadvertently placing someone on a pedestal. That person represents a source of “all that is good,” and some people with BPD report feeling that they quickly become obsessed with being close to that person. Unfortunately, this can result in a pattern of clinginess and jealousy.
Undervaluing can also happen. Undervaluing refers to mistreating a loved one. For someone with BPD, this tends to occur when they have felt rejected or misunderstood.
It’s also possible for someone with BPD to alternate between overidealizing and undervaluing. At one moment, they might treat someone like a best friend. But that can change rapidly, and it may be confusing for others.
Frequent Mood Swings
BPD is also characterized by difficulties with emotion regulation. It’s common to oscillate between feeling ‘hot and cold,’ and feeling triggered can happen very quickly.
It’s important to note that these mood swings also feel difficult to control. For example, someone with BPD might identify that their anger is irrational, but that insight doesn’t improve the situation. In addition to anger, they might also be prone to extended episodes of sadness or panic attacks.
These mood swings often result in relationship problems. Other people worry about saying or doing the wrong thing, which may cause them to withdraw. Or, they might try to set boundaries, which can feel like a rejection for someone with BPD.
Patterns of Self-Sabotaging Behavior
People with BPD often try to manage their emotions in various ways. Some of these coping mechanisms, however, can be problematic and may perpetuate more suffering.
Self-sabotage can include any excessive or dangerous habit, including substance abuse, binge eating, spending or gambling excessively, or having unprotected sex. Some people may engage in multiple habits at varying intensities.
With that in mind, it’s not uncommon for someone with BPD to first seek mental health treatment for an addiction or eating disorder. Many times, those symptoms act as a primary motivator in getting more support.
Perpetual Feelings of Emptiness and Boredom
People with BPD tend to feel like they lack a true sense of self. There’s often this deep void inside, and it can seem like nothing fills that space. As a result, they may feel worthless or bored throughout the day. Patterns of self-sabotage sometimes fill the void, but the effects are always temporary.
Subsequently, dissociation is also a common feature of BPD. Dissociation refers to feeling disconnected from your reality. Some people describe it as seeing themselves outside of themselves. Others have more of an emotional response to being out of reality.
Unstable and Undefined Self-Image
Identity disturbance is another common feature of BPD. This refers to feeling inconsistent with one’s own sense of self. As a result, a person with BPD may naturally take on the values, interests, or desires of another person.
Identity is a broad term, but it can include everything from personality and temperament to opinions and social roles. People begin developing their identities in childhood, but people with BPD may not have had this opportunity when they were younger. If their caregivers didn’t encourage the exploration of self, such growth can be stunted.
This undefined self-image impacts self-esteem. But it can also make it extremely difficult to form meaningful relationships with others. Without a clear identity intact, it can be hard to know how to set boundaries and whom to spend time with.
History of Self-Harm and Suicidal Ideation
Self-harm and suicidal ideation can occur in all mental illnesses, but they tend to be more prominent in BPD. Research also shows that people with BPD are far more likely to experience these symptoms.
Self-harm often acts as a method for regulating emotions or reducing discomfort. Self-harm can also be a form of self-punishment and sensation-seeking. Many people find that it also provides a feeling of control, which can be soothing if the rest of the world feels out of control.
Suicidal ideation can be a manifestation of the distress associated with BPD. This effect may be even more amplified in people who have strong insight into their condition. They may have shame about their symptoms or worry that things will never improve.
Lesser-Known Symptoms of BPD
BPD symptoms are not always straightforward. An accurate diagnosis requires the presence of the main symptoms listed above. However, there are also nuanced symptoms worth noting.
Many people with BPD also meet the criteria for anxiety or depressive disorders. The mental toll associated with these conditions can be exhaustive. Furthermore, problems with self-care might make it difficult to prioritize nutrition, physical activity, or good sleep habits, all of which can impact energy.
Avoiding Talking to Others When Distressed
BPD can sometimes result in serious confrontations in interpersonal situations. However, some people with BPD withdraw when they’re mad or avoid talking to others. These shutting-down reactions are usually out of a desire to maintain a level of peace. However, it can lead to self-isolation, which can exacerbate feelings of loneliness and low self-worth.
Some people with BPD are very high-functioning in certain settings, such as at school, work, or within certain relationships. This is known as situational competence, and it speaks to the intelligence and resilience many people with BPD have. However, being so high-achieving can also convince people they must not really be in distress, even when they’re struggling.
Problems Accepting Criticism or Feedback
Because the fear of abandonment is so prevalent in BPD, people with this condition resist rejection as much as possible. As a result, they often present as unreceptive to any feedback that feels critical. Even a small suggestion can result in them feeling deep shame or anger.
Paranoia in Relationships
People with BPD often worry that others will hurt them. Therefore, they tend to be suspicious, even with strangers. They may not want to let their guard down and be vulnerable. In relationships, this paranoia can present as clingy behavior, accusing of infidelity, or assuming the other person will leave them. At the same time, someone with BPD struggles with the competing need to feel connected and loved.
The people-pleasing feature of BPD often results from a combination of fearing abandonment, an unstable sense of self, and perpetual feelings of emptiness. In all of this, there is a longing that someone else can help them feel better about themselves. Therefore, they might, at times present passively with others.
How Is BPD Diagnosed?
There isn’t one specific assessment that diagnoses BPD. However, your healthcare provider may use different tests and clinical observations to make a working diagnosis. They might also ask to speak to other people who know your mental health history, including your parents, primary care physician, or partner.
In recent years, the diagnosis of BPD has been challenged by many mental health professionals. Because most people with personality disorders have histories of complex trauma, it can be challenging to discern a C-PTSD differential diagnosis with BPD.
That said, if you suspect you have BPD- or are concerned about some of your mental health symptoms- it’s worth talking to a therapist. Even if you don’t meet the full criteria for a personality disorder, your symptoms are valid, and you are worthy of getting support.
What Happens After a BPD Diagnosis?
A diagnosis is really just a term that names a collection of symptoms. It does not indicate that you are broken or bad in any way. However, coming to terms with a BPD diagnosis can be difficult, especially since this particular diagnosis sometimes comes with a stigma.
Personality disorders are not curable. However, they are treatable, and taking care of yourself can improve your self-esteem, relationships, and overall emotional well-being. Working with a skilled therapist is often the first step of a multifaceted treatment process.
If you identify with certain BPD symptoms, you may feel worried or upset. You might also wonder if you’re looking too much into things. Although most therapists recognize the merit of exploring self-diagnosis, it’s always a good idea to seek a professional consultation. You don’t deserve to suffer, and if you’re having a hard time, help is available.