The title, “I Hate You – Don’t Leave Me!” authored by Straus and Kreisman sums up perfectly the experience of someone suffering from Borderline Personality Disorder (BPD). A lot can be written about this diagnosis but I want to touch on just a few aspects of it; misnomer, misdiagnosis, some basic characteristics, and treatment.
Misnomer
As with so much in the medical world, understandings of various conditions progress. One of the bones I have to pick with the category of “personality disorders,” is that they’re not disorders – they’re diseases, and as a social worker, I’m trained to use a strengths-based approach to help the person sitting across from me. Seeing the person who has a sickness is very different from seeing someone who is the sum of their diagnosis.
Misdiagnosis
Many therapists and their practices shy away from treating those who suffer from BPD. It’s a difficult condition to treat and it is often misdiagnosed as Bipolar Disorder. Why the confusion? Those with Bipolar Disorder are typically thought of as having mood swings, and they do, but they look very different than someone who has BPD. Due to that confusion, medication is often prescribed and frustration sets in when after numerous combinations, nothing seems to help.
Characteristics
The DSM-5 defines BPD as a pervasive pattern of instability in interpersonal relationships, self-image, and affects, along with marked impulsivity, starting by early adulthood. It is marked by having at least five of the following nine symptoms:
- Abandonment Fear: Frantic efforts to avoid real or imagined abandonment.
- Unstable Relationships: A pattern of intense, unstable relationships alternating between idealization and devaluation
- Unstable Self-Image: Markedly and persistently unstable sense of self.
- Impulsivity: Self-damaging impulsivity in at least two areas (e.g., spending, substance abuse, reckless driving, binge eating).
- Self-Harm/Suicidal Behavior: Recurrent suicidal threats, gestures, or self-mutilating behavior. ● Affective Instability: Intense mood swings (e.g., intense episodic dysphoria, irritability, or anxiety) lasting hours to days.
- Emptiness: Chronic feelings of emptiness.
- Intense Anger: Inappropriate, intense anger or difficulty controlling anger.
- Paranoia/Dissociation: Transient, stress-related paranoid ideation or severe dissociative symptoms.
As you can see, there’s nothing pleasant or comfortable about this.
Treatment
BPD is difficult to treat and it can be complicated by having other needs such as treatment of
Depressive, anxious, or Bipolar disorders, and medication can address those, but BPD itself is not treatable with medication, only therapy can help with this condition.
The gold-standard of treatment for BPD is to find someone certified in the treatment modality of Dialectical Behavioral Therapy (DBT). Around since the 1970s, DBT shows itself incredibly successful, when done properly, to treat and bring healing to those with BPD. It integrates group work and skill-building along with some other tools and supports to facilitate treatment.
Light and Life Therapy has several providers certified in DBT and we lean in to helping those with more difficult diagnoses, like BPD, to heal. If you, or someone you know, seems to fit the description above, time is of the essence and we can help!
