Borderline personality disorder is a complex mental illness. Trying to describe it “is like staring into a lava lamp: what you see is constantly changing. The illness not only causes instability but symbolizes it.” (Janice Cauwels, Imbroglio: Rising to the Challenges of Borderline Personality Disorder)
BPD could well be the most misunderstood psychiatric diagnosis. People suffering with the disorder are usually diagnosed in their early 20s and there’s a lot of stigma associated with the BPD diagnosis. The movies Girl, Interrupted, Fatal Attraction, and Single White Female centered around seriously disturbed main characters with borderline personality disorder tendencies.
It’s been said that borderline patients are the ones mental health practitioners fear the most. That’s partly because approximately 75% hurt themselves and an estimated 10% commit suicide, an extraordinarily high rate. Another reason is because borderlines often manipulate and emotionally abuse their caregivers to the point that many psychologists refuse to treat them.
The truth is many therapists are clueless when it comes to treating borderlines. This is especially frightening when you consider the diagnosis of BPD is on the rise. In 2008 a study of 35,000 adults found that 5.9% of them had received a BPD diagnosis. Eight years prior in 2000 only 2% were diagnosed with BPD. It is now estimated that BPD affects up to 3% of the U.S. population.What exactly is borderline personality disorder?
One of the world’s leading BPD experts, Marsha Linehan, describes it like this: “Borderline individuals are the psychological equivalent of third-degree burn patients. They simply have, so to speak, no emotional skin. Even the slightest touch or movement can create immense suffering.”
According to the Diagnostic and Statistical Manual the diagnostic criteria for BPD is as follows:
“A pervasive pattern of instability of interpersonal relationships, self-image, and affects (moods), and marked impulsivity beginning by early adulthood and present in a variety of contexts, as indicated by five or more of the following:
- Frantic efforts to avoid real or imagined abandonment.
- A pattern of unstable and intense interpersonal relationships, altering between extremes of idealization and devaluation.
- Identity disturbance: markedly and persistently unstable self-image or sense of self.
- Impulsivity in at least two areas that are potentially cell damaging (e.g., spending, sex, substance abuse, reckless driving, binge eating).
- Recurrent suicidal behavior, gestures, or threats, or self-mutilating behavior.
- Mood instability such as intense episodic dysphoria, irritability, or anxiety usually lasting a few hours.
- Chronic feelings of emptiness.
- Inappropriate, intense anger or difficulty controlling anger.
- Transient, stress-related paranoia.”
The exact cause of BPD is unknown but it’s believed to be a mixture of both nature and nurture. In other words it’s a volatile combination of genetic and environmental misfortune. Borderlines often come from abusive homes, physically, sexually, or emotionally, or they may come from “normal” families simply trying to deal with the stress of the economy or some health related crisis... and the kids fall between the cracks.
Why the borderline diagnosis is on the rise.
There are a few theories that explain why BPD is rising. One is that because of advances in recognizing and treating mood problems like short-term depression, there are more resources to identify more difficult disorders like BPD. There is a more hopeful explanation and that is that the treatment has seen a dramatic improvement over the years. One study reports that 88% of people who had received the BPD diagnosis and received proper treatment no longer fulfilled the BPT criteria a decade later. As a matter of fact, for most there was some improvement within a year.
If someone you care about may fit the criteria for borderline personality disorder, know that there is hope. And if you are living with someone with BPD is essential that you get help as well. Living with BPD is extremely difficult for both the borderline and the people that love them.