Borderline Personality Disorder
If you’ve found your way to this page, you may have recently been diagnosed with borderline personality disorder (BPD), or perhaps you’ve read about it and find that you can relate. BPD is an often-misunderstood diagnosis. It describes a pattern of pervasive problems regulating emotions, which can lead to frequent self-destructive behaviors, intense and unstable relationships, and an unstable sense of self.
Marsha Linehan, PhD, conceptualized BPD as consisting of five types of dysregulation: emotional, behavioral, interpersonal, cognitive, and self. Let’s explore what each of these might look and feel like for the person struggling with BPD.
What Does BPD Look and Feel Like?
Emotional dysregulation - You might feel tortured by your emotions on a regular basis. The more you try to gain some sense of control over how you’re feeling, the further you sink into misery, like struggling in quicksand. High reactivity, angry outbursts, irritability, and depressive episodes are all quite common in BPD.
Behavioral dysregulation - To gain a sense of relief from spiraling, out-of-control emotions, you might resort to impulsive solutions that provide a temporary sense of control, such as self-injury, suicide attempts, or lashing out at others. Once the brief relief has passed, you find that you’ve now made your situation worse. You may feel resultant shame, guilt, regret, or even self-hatred. Thus, the cycle of emotion dysregulation continues.
Interpersonal dysregulation - Folks with BPD usually experience a pattern of intense and unstable relationships. You may find that you desperately crave a deep, intimate relationship and that you often bypass the getting-to-know-you stage, becoming attached quickly. Your relationships can be marked by intense conflict and chaos, as well as frantic efforts to avoid losing the relationship. This may alternate inexplicably between pulling people closer to you and pushing them away.
Cognitive dysregulation - In intensely stressful situations, such as the threat of being abandoned, your thoughts may become briefly dysregulated. You may experience moments of involuntarily disconnecting from reality, feeling outside of your body, or as though the world isn’t real. Others may tell you that you seem far away.
Dysregulation of the sense of self - This may show up as feeling a sense of emptiness and lacking a consistent sense of self. You may look to others to define who you are, or find that your identity changes from moment to moment or from relationship to relationship.
What are the causes of BPD?
Arguably, our best working theory to explain the causes of pervasive emotional dysregulation is Dr. Linehan’s biosocial theory. She proposed that biological factors interact with the person’s early environment to create the patterns we see in BPD.
A biologically vulnerable person is more emotionally sensitive. They may perceive things around them that others don’t pick up on. They may experience their emotions more intensely and suddenly. And they may take a longer time to return to baseline after experiencing emotions.
The social part of biosocial theory is referred to as the invalidating environment. This can be the family system, the school, teachers, or even the culture at large. An invalidating environment is one that consistently misunderstands who you are, criticizes you, and negates your perceptions and experiences.
The pairing of this invalidating environment with a person who is already biologically vulnerable often leads to a pattern in which the escalation of emotions and maladaptive behaviors is the only way to get needs taken seriously. This setup tends to reward extreme behaviors and punish more effective and appropriate ones.
Can BPD be Treated?
It was once thought that BPD could not be treated effectively, but clinical research has come a long way. There is a huge body of evidence supporting the existence of multiple treatments that can immensely improve the lives of those suffering with BPD. These include dialectical behavior therapy (DBT), mentalization‐based therapy, and transference‐focused therapy. Of these treatments, DBT has the most robust evidence base.
I’ve worked with clients with BPD since 2014, when I began working in an outpatient hospital clinic setting. In 2015, I received training in DBT from Behavioral Tech Institute. The dialectical philosophy of DBT resonated with me as a way to view the world. And DBT’s structured, results-oriented approach fit my personality, as I’m a problem-solver by nature. I was hooked! I decided to undergo the rigorous process of getting certified by the Linehan Board of Certification.
If you’ve struggled with BPD for years, you may feel hopeless about the possibility of change. Perhaps you’ve dropped out of treatment before, or had therapists drop you because they didn’t feel equipped to address the behaviors you struggle with. It can feel really vulnerable and scary to start with someone new. It may even be painful to allow yourself to dream about the future, because it brings up so much pain about the past.
I want to dare you to dream about the life you want, because I know there is good reason to be hopeful. Over the years, I have seen many clients with BPD decrease their suffering considerably and start to build a life filled with the things they value most. The work is difficult, but you won’t be in it alone. I’d be honored to be your guide and support on your journey toward building a life worth living.