What is Borderline Personality Disorder?

For my very first informative post, I felt it was necessary to discuss what Borderline Personality Disorder really is, because in my humble opinion, the term “borderline” is extremely misleading.    

First off, what is a personality disorder? 

According to the American Psychiatric Association, personalities show our own individual “way[s] of thinking, feeling, and behaving” that may differ from those around us. Our personalities are affected “by experiences, environment...and inherited characteristics.” Our environment doesn’t necessarily mean just our surroundings; it also includes past and present situations that affect us. A personality disorder occurs when our personality differs from the cultural norm and causes issues and distress over time. 

There are ten different types of personality disorders. I won’t get into the specifics of each, but I feel personally victimized by the definition of Borderline Personality Disorder on www.psychiatry.org. It reads, a person with borderline personality disorder will display “a pattern of instability in personal relationships, intense emotions, poor self-image, and impulsivity. A person with [BPD] may go to great lengths to avoid being abandoned, have repeated suicide attempts, display inappropriate intense anger or have ongoing feelings of emptiness.” As reported by www.verywellmind.org, the term “borderline” was chosen by “early psychiatrists [because they] believed the symptoms of BPD were ‘on the border’ between neurosis and psychosis.” 

The DSM-5 (the Bible for Psychiatrists) lists 9 characteristics of people likely to be diagnosed with BPD. If you are exhibiting five or more of these characteristics, it wouldn’t hurt to ask your psychiatrist to rule this out as you search for your own correct diagnosis. The characteristics are as follows: 

1. Fear of Abandonment

2. Unstable or changing relationships 

3. Unstable self-image, struggles with identity or sense of self

4. Impulsive or self-damaging behaviors (e.g., excessive spending, unsafe sex, substance abuse, reckless driving, binge eating). 

5. Suicidal behavior or self-injury

6. Varied or random mood swings

7. Constant feelings of worthlessness or sadness

8. Problems with anger, including frequent loss of temper or physical fights

9. Stress-related paranoia or loss of contact with reality

So, you must be asking, what does BPD look like in real life? Lucky for you, I am a living, breathing textbook example of a patient with borderline. I check off EIGHT of the nine criteria; the only one I don’t experience is #9 on that list, but even then, I wonder if during some of my worst episodes if I haven’t lost touch with reality. Originally, I planned to include my background with each one, but I realized that it would make this post EXTREMELY LONG, so follow up posts on my experiences with these characteristics are coming soon. 

It is also important to note that many therapists and psychiatrists have told me that borderline personality disorder occurs on a spectrum and I fully support this as a person with this diagnosis. Being on a spectrum means that symptoms can vary from mild to extremely severe, based on the patient. For example, I struggle with anger only on occasion when I am extremely triggered and am not able to calm down, while former NFL superstar Brandon Marshall struggled intensely with anger, to the point he was famous for his explosiveness on and off the field on a regular basis. (PS-the more I learn about Brandon Marshall the more I say, “PREACH,” and admire him for his vulnerability and commitment to education on mental health and compassion and empathy for those who suffer from it). 

In the short few months since my diagnosis, I have learned that the research on borderline is 20-30 years behind the studies of other mental illnesses, according to several mental health professionals I have spoken with. Isn’t that bonkers? 20-30 YEARS? It is also important to note that many people are misdiagnosed (me included) and the probable number of people with BPD is far greater than what has been originally estimated. 

While I am obviously not a psychiatrist or therapist, I do see that professionals are hesitant to diagnose borderline. Want to guess why? Unlike bipolar disorder, which is commonly controlled via lithium or other mood stabilizers, BPD can be extremely difficult to treat, as there is no medication to control symptoms. Sure, you COULD pop a vistaril (a mild antihistamine commonly prescribed for its calming properties, plus it’s NOT a benzo, which many people with BPD cannot take due to their issues with substance abuse) or an Ativan when you get super elevated and are feeling volatile, but that is a short term fix and will not prevent another similar episode from occurring. It will happen again if borderline is your true diagnosis and you do not have the right skills to help yourself in those crashing waves of depression or volatility. 

So you must be asking, what do you do to help your BPD? Well, let’s just say dialectical behavior therapy is my therapeutic best friend. Created by Marsha Linehan, DBT is a branch of cognitive behavior therapy. Essentially, being dialectical means that you accept two opposites that are both truths. For example, one trigger I have with my borderline is others being pregnant and babies in general. While I will delve into this trigger later on, I am both sad for myself because we choose not to have more children at this moment because I need to be emotionally stable for an extended period of time, but I am also extremely happy for my friends and family during their pregnancies and baby-hoods. These are two opposites that are both truths. 

There are four main pillars of DBT: Mindfulness, Distress Tolerance, Interpersonal Effectiveness, and Emotional Regulation. One thing I personally find SUPER effective for me in DBT is the emphasis not just on changing your thinking, but also changing your behavior. In each of these four pillars, there are actual ways to DO things differently. For example, in Distress Tolerance, there are crisis management skills called TIPP. In TIPP, you change your body TEMPERATURE, do INTENSE exercise, PAIRED muscle relaxation, and PACED breathing. Again, I have several posts planned for discussing DBT, so I won’t go into that much detail. HOWEVER, know that DBT is not just processing triggers and then feeling better. It is HARD work and many people struggle to commit to a dialectical life, which is why I think doctors are hesitant to diagnose borderline right away. It is far easier to pop 100mg of Lamictal than it is to do years of group DBT therapy, individual DBT therapy, application of DBT therapy, and more. Unfortunately for me, I tried ALL the SSRIs, SNRIs, and mood stabilizers, hoping to find one that stuck and made me stable. That never happened, in a borderline sense. 

While I plan to talk about my journey towards my diagnosis in yet another post, I feel that it's important to note I went misdiagnosed for many years. I had a psychiatrist tell me that it sounds like I had borderline tendencies from when I was a teenager, but my former psychiatrists then probably weren’t concerned about a BPD diagnosis because what teenage girl is NOT on an emotional rollercoaster daily? My borderline came to full fruition when I was 27 when I experienced trauma after a pregnancy loss. I said for the years after our miscarriage that I haven’t been the same and I have been SO much more emotionally reactive since, more so than ever before. 

So, in closing, or rather in starting, of what I pray is a validating and informational source of hope, I hope you know that you are not alone in this. I believe in you and you will get through this. For it is in suffering that we can truly appreciate peace in our own hearts. 

Love in grit and grace, Ellie

PS-I want to give credit where credit is due. I am NOT a mental health professional in any capacity (besides maybe the cost of 20 plus years of copays and mental health hospital bills that could add up to pay for a masters’ in counseling or psychology) and I have chosen to use and cite the real words of professionals. If you notice I need to give additional/different citations, PLEASE LET ME KNOW!