BPD: Basic Information, Providing Compassion, and Determining Boundaries with Borderline Personality Disorder (Part 1)
Borderline Personality Disorder (BPD) has become a more heavily discussed mental illness diagnosis in recent years due to more exposure in the media. Its increased discussion, however,
has also brought more misinformation about a complex and misunderstood diagnosis.
What is Borderline Personality Disorder?
BPD, by definition, is a chronic or pervasive pattern of behaviors that create dysregulation of emotion, thoughts, social relationships, behaviors, and sense of self.
BPD forms from a biosocial transaction, which means that an individual with a BPD diagnosis is influenced by both predetermined traits, such as their biological, emotional sensitivity, and hyperactivity, and environmental factors, such as their familial upbringing. While trauma is often a shared experience of those with a BPD diagnosis, this transaction between one’s nature and nurture strongly influences how they are emotionally responsive.
Growing up, we influence our environment, and our environment influences us. Should an individual with a predetermined emotional sensitivity and higher hyperactivity be born into a family where emotions are seen as weakness or undesired, the individual will grow up in a poorness-of-fit within their environment. Poorness-of-fit is when someone’s emotional and mental needs do not match the capabilities of their environment to meet those needs. They will then not grow up in an environment that helps them nurture their emotions or learn how to manage them safely.
With an underlying poorness of fit and exposure to abuse, abandonment, loss, and trauma, an individual will continue to develop physically, but emotionally, an individual may struggle to develop. Suppose they were not provided with the environment and support to learn about their emotions and how to express them. In that case, they may struggle to regulate themselves when an emotion becomes too intense to sit comfortably.
Think about it. The times in which you probably learned the most meaningful lessons were probably in environments where you felt comfortable making mistakes. If you felt a large and uncomfortable emotion in an environment where having an emotion was seen as “wrong,” you would not learn how to manage it. Instead, you might learn that emotions make you unsafe, weak, a burden, or unheard, so you might learn to hide, mask, avoid, or lash out. This message then infiltrates how you make sense of and react to the world, and your emotional maturity stalls at the age this message was received.
After years spent in this cycle of feeling an intense emotion, feeling inner shame or fear of the emotion and its intensity, and not knowing what to do with it, you may learn to live in a state of chronic dysregulation.
Suppose this pattern sounds like you or someone you love. In that case, that can be incredibly exhausting, especially in a world where emotional regulation is expected even if you were never taught it. It would be completely normal and valid to feel a sense of disconnection from others, the world, and yourself.
The 5 Types of Dysregulation in BPD
Dysregulation of Emotions
Due to the factors that lead to the onset of BPD, individuals with a BPD diagnosis have thinner emotional skin than those who do not have a BPD diagnosis.
By thinner emotional skin, I mean that someone with a BPD diagnosis experiences emotions at a more raw level than someone without one. In someone with BPD, their emotional baseline is set to a higher rate, causing them to be more reactive to emotional stimuli and for emotions to flood in quickly, all at once, and at the same time. To understand the emotional experience of BPD, it can be helpful to imagine that someone’s emotions are amplified.
When someone without a BPD diagnosis experiences anger, they will feel the common signs of anger with increased heart rate, flushed skin, heat in their face, and increased fight response. However, when someone with a BPD diagnosis experiences anger, their anger begins boiling and turns into rage. Typical expressions of sadness appear as anhedonia, anxiety turns into debilitating fear, and happiness becomes euphoria.
Individuals diagnosed with BPD experience a wide range of emotions and a frequent fluctuation between emotions in a shorter span of time compared to individuals who do not have a BPD diagnosis. Emotions may also be more challenging to manage due to their intensity, and it can be shared for individuals with a BPD diagnosis to report experiencing times of “numbness” in between these intense emotions.
I often tell my clients with a BPD diagnosis that the diagnosis is an indicator of an emotional superpower. With someone of their emotional skin, they will feel emotions more deeply in a single day than most people may feel in their entire lives. In a way, individuals with a BPD diagnosis achieve a more human experience than many individuals. They can experience beauty, love, loyalty, and passion at a unique level.
However, with such a potent superpower can come equally potent challenges, such as experiencing ugliness, hate, infidelity, and anhedonia at an equally unique level, which can be incredibly difficult to regulate internally.
Dysregulation of Thought
Dysregulation of thoughts stems from a pattern of black-and-white thinking when one’s thoughts resemble a see-saw fluctuating from one end of a spectrum to the other
For example, the famous “he loves me, he loves me not” shows black-and-white thinking because of the “either-or” mentality. In black-and-white thinking, gray does not exist; therefore, someone is either terrible or terrific, the world is open for opportunity, or it is ending, or someone is in love with me or will abandon me. That is where individuals with a BPD diagnosis can struggle most when their thoughts consist of extremes, and their emotions match the intensity of those extremes.
Additionally, individuals with BPD can experience thought patterns that align with the messages they received from their environment and trauma, resulting in a continual perspective of the world being unsafe and untrustworthy.
Individuals can develop magical thinking, in which thoughts resemble a child's. In this pattern of thinking, we can identify the thoughts that orient around words like “should,” “shouldn’t,” “ought,” “must,” narratives about the past and future, assumptions, and pessimism. We may also notice internal self-talk, such as self-labeling, self-shaming, and self-moralizing. When these thoughts occur automatically and without awareness, they can take over our perception of the world and our ability to cope with discomfort.
It can often be difficult for individuals with BPD to decipher between an all-or-nothing thought and an extreme emotion, which can cause both to exist as a truth requiring immediate attention and reaction. This is when individuals face social difficulties, impulsive behaviors, and an unstable sense of self.
Dysregulation of Social Relationships
With this dysregulation occurring internally, individuals with a BPD diagnosis can experience more fluctuation in their social lives, including unstable relationships and more social conflict. Individuals with BPD are more susceptible to a pattern of behavior called splitting, which is when an individual is either their “favorite person” or they cannot be around that person at all.
Splitting is often a trauma response. When triggered, an individual with a BPD diagnosis can switch off their affection for another person as a means to protect themselves from the pain of any perceived abandonment, a pervasive fear in individuals diagnosed with BPD.
As individuals with BPD have raw fight/flight/freeze responses, how they respond to a threat, social interactions can be an incredible protective factor and an equally incredible risk factor. Especially when an individual with BPD has emotional and mental needs that are not being met. When individuals do not have the resources to meet their needs or ask for them to be met, they resort to behaviors that they know will help them achieve their needs, but often in maladaptive ways.
Therefore, behavior is not always intended to be manipulative. However, without experience in navigating intense emotions, challenging thoughts, and an underlying trauma with unsafe individuals, learning to ask for these needs to be met may feel nearly impossible.
Dysregulation of Behavior
Individuals with a BPD diagnosis can experience dysregulation in their behaviors, causing impulsive behavior, substance use, aggression, self-harm, and suicide.
In combination with distressing thoughts and intense emotions, individuals with a BPD diagnosis are at a higher risk of suicide. Suicidal thoughts, behavior, and self-injury can be everyday actions and coping mechanisms of individuals who have not been provided with skills and means of coping.
In addition to suicidality or self-injurious behaviors, individuals with a BPD diagnosis can struggle with impulsivity, such as reckless driving, spending, sexual behavior, drug use, gambling, and binge eating. These behaviors can occur due to difficulty connecting with reality and the impact of these actions or the difficulty in controlling impulses.
Additionally, with impulsivity and hyperactivity, individuals can struggle with moments of intense rage and can lash out in an attempt to expel the discomfort of their rage.
This impulsivity can be driven by fluctuating emotions, extreme thoughts, and fight/flight/freeze responses.
Dysregulation of Sense of Self
Lastly, individuals with a BPD diagnosis can often struggle with having a stable self-conceptualization.
This struggle may cause them to continually change interests, identities, aspirations, and life paths due to a survival response of adapting to please others, avoiding unsafe social situations, or impulsivity. It is also common for individuals to struggle with a sense of identity when growing up in an environment of poor fit or after surviving trauma, as you cannot truly learn about yourself and explore who you want to be when in perpetual survival mode.
Additionally, individuals with BPD may also struggle with their physical self-concept. Some physical challenges include challenges with body image and body dysmorphia, a mental health condition in which one struggles to perceive their body as it appears. This skewed perspective may cause an individual to fixate on a perceived flaw.
Individuals with a BPD diagnosis can also struggle with a stable self-concept in terms of their reality. A common symptom of BPD is dissociation, a condition typically found in trauma disorders. When individuals dissociate, they may feel disconnected from their reality (derealization) or their own body (depersonalization).
Moving Forward with BPD
Now that you know BPD and how it can appear in individuals, you may feel more familiar with experiences you have noticed in yourself or those you have witnessed in a loved one. When you believe you or someone you love could be struggling with BPD, it is essential to check the facts, hold compassion, and establish boundaries. To learn more, check out Part II of this blog post!
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Written by: Sophie Koch, LGPC
Sophie is a LifeSpring therapist who offers online and in-person counseling services to adolescents and adults (15 and up) to offer help with depression, anxiety, borderline personality disorder, trauma, and mood disorders.
