Borderline Personality Disorder – What is it?
DR. ESSLIN TERRIGHENA explains what Borderline Personality Disorder is and how to recognize the symptoms.
Borderline Personality Disorder (BPD) is characterized by two key factors: difficulties in emotion regulation and difficulties in attachment. This means that if we are dealing with BPD, we may experience intense, overwhelming or all-consuming feelings that we feel powerless to soothe or regulate our reactions to. Further, we may experience high levels of distress in interpersonal relationships. This can be driven by a fear of loss and abandonment, explosive anger and mood swings, or intense ups and downs in how we feel about the other person.
The diagnostic manual DSM-V outlines nine symptoms of BPD, which can be categorized under emotional instability, cognitive instability, and interpersonal instability.
Symptoms of emotional instability include high levels of emotional reactivity to triggers, which can last a few hours to a few days (symptom 1), intense anger outbursts (symptom 2), chronic feelings of emptiness (symptom 3), self-harm or suicidal ideation (symptom 4), or impulsivity that drives us to engage in risk-seeking behaviours (symptom 5).
Feelings often take the form of intense anxiety, sadness, or anger that are accompanied by strong physical sensations. This experience can mean we have been triggered into survival mode by a perceived threat in our environment. As a result, we may have an emotional response that feels so overwhelming that it is difficult to think clearly, even if we are not sure what the trigger was or logically think it was not significant. We may feel that it is impossible to soothe or control these feelings and they can significantly interfere with our functioning in our personal or work lives.
Anger can be particularly destructive as it may show up in sudden rage outbursts that can damage relationships and subsequently, reinforce feelings of loneliness, emptiness, abandonment, and regret. The chronic emptiness can further make it challenging to be by ourselves.
In BPD, attempts to reduce the distress intensity may lead us to engage in damaging behaviours, such as self-harm, suicidal gestures, threats or behaviours, or impulsive risk-seeking actions. Impulsivity can be channeled into shopping sprees, substance abuse, excessive eating or sex, or reckless driving, and can feel compulsive or even manic. After engaging in such actions, we may feel guilty or ashamed, further impacting our mood and negative thoughts about ourselves.
Symptoms of cognitive instability can show up as s persistently unstable sense of self and identity (symptom 6), distortions of how we perceive ourselves, other people, or the general environment, and short-term paranoia or dissociation (symptom 7).
The unstable sense of self in BPD may be felt as sudden changes in self-image, values, beliefs, or goals. It can involve uncertainty about who we really are, and what our true likes and dislikes are. It may also seem that we act extremely differently when we are with different groups of friends, almost becoming an entirely different person depending on what is expected of us. This can make us feel disconnected from ourselves and reduce our sense of self-esteem, self-confidence, self-worth, and self-efficacy. It can also make us feel highly enmeshed with people close to us, taking on their feelings and preferences, while losing touch with our own.
Cognitive distortions in BPD are thought patterns that may be exaggerating or misinterpreting the reality around us. Often they are automatic and occur in response to a trigger that activates a particular thought network. For example, criticism at work may trigger underlying fears that we are not good enough. While activated, memories may pop up that seem to confirm that we are not and never have been good enough. Later that day, someone might ask a challenging question in a meeting that we do not have an answer for. This automatically feeds the same narrative that we are not good enough. While often we can bat such negative thoughts away and remind ourselves of our achievements, once activated, cognitive distortions can feel very real and distressing. This can lead to confusion as to what is real and what we are seeing a certain way based on our pre-existing fears and beliefs. Distortions can escalate to paranoia, for example that everyone at work wants to see us fail, and dissociation, where we become detached from ourselves and the reality around us.
Symptoms of interpersonal instability include frantic efforts to avoid real or imagined abandonment (symptom 8), and unstable and intense interpersonal relationships linked to alternating between idealization or devaluation of the other person (symptom 9).
Fear of abandonment is often at the heart of interpersonal instability in BPD. If we have BPD, it can feel overwhelming when we feel someone withdrawing. Sometimes it can feel so raw that we feel we cannot survive the emotional distress. We may be inclined to cling to people so they will not leave, or, the opposite, push people away before they can hurt us. This can contribute to impulsive decisions and unstable relationships.
Instability can be further enhanced through so-called splitting, whereby BPD may cause us to flip between idealization and devaluation of a person or a relationship. In an idealization phase, we may find they can do no wrong and that they are perfect in every way. Conversely, in a devaluation phase, we may experience feelings of dislike, mistrust them, see only their flaws, or even feel disgust and hatred toward them. In both these phases, it is difficult to see the other person for who they truly are and for their whole self, which includes their strengths and their weaknesses. Often moving from one extreme to the other can be triggered by an action of the person, and happen within seconds, feeling very intense and de-stabilizing. This may make it difficult to trust our gut feelings as the process can be highly confusing.
Therapy has been shown highly effective for easing the symptoms of BPD, and improving emotion regulation, interpersonal attachment, and cognitive control. If you are experiencing symptoms of BPD and want to find out how therapy can help you, please book a consultation with with Dr. Terrighena on (852) 2521 4668 or firstname.lastname@example.org.