Understanding BPD

Early researchers named the disorder “borderline” because they thought it was a bordering form of schizophrenia and also because it was thought to exist on the border between neurotic and psychotic behavior. The rationale for the name no longer makes sense but it has stuck.

In his book BPD Demystified, Dr. Robert O. Friedel writes that medical literature first described people demonstrating symptoms of borderline personality disorder nearly 3,000 years ago. In 1938 the American psychoanalyst Adolph Stern published an article on BPD describing its primary diagnostic criteria. Additional research and publications over the next four decades led to the American Psychiatric Association formally recognizing BPD as an official psychiatric diagnosis in 1980.

The American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5)[i], delineates the diagnosis of BPD on the basis of (1) a pervasive pattern of instability of interpersonal relationships, self-image, and affects, and (2) marked impulsivity beginning by early adulthood and present in a variety of contexts, as indicated by at least five of nine specific characteristics that I listed in Chapter 16.

Even with a clinical definition, actually understanding BPD can be challenging to a layperson like me. I found it helpful to think about the all-or-nothing thinking that often is part of BPD. When we asked Taya why she hadn’t done her chores, she seemed to interpret that to mean that we thought that she was all wrong, a bad person. She didn’t like hearing that so she lashed out at us and then self-harmed as a way to punish herself for being so bad. Likewise, if we didn’t do what she asked, such as refraining from touching our toes, it meant to her that we didn’t love her so she fought back at us and, again, self-harmed. I am heartbroken when I think about how painful it was for her to deal with these feelings on a daily (or hourly) basis.

Kiera Van Gelder, an author with BPD, describes this type of all-or-nothing thinking in her book The Buddha and the Borderline, writing about her new boyfriend, “He doesn’t turn the radio down like I ask him to, so I decide that means he doesn’t care about me and I spend the rest of the day strangled and stupefied by the emotions from just this one slight.”[ii]

What makes this type of thinking even worse is that everything is temporary. The person with BPD wakes up each morning unsure if she is loved, if she is good or bad. Each of us is connected to our loved ones and friends by invisible ropes of varying lengths and strengths binding us together. While most of us accept that the ropes are solid, the person with BPD may need to yank on each rope multiple times a day to see if it’s still there.

A friend of ours has a grown daughter with BPD who refused to see our friend for over ten years. Then one day, the daughter invited her mother over. Our friend visited her daughter daily for two weeks, spending time with her daughter and developing a relationship with her grandchildren. Our friend said something innocuous during a visit that her daughter perceived as a dagger that ‘proved’ she wasn’t loved, so she cut her mother off again. Our friend has no idea what she said wrong, but she is now barred from seeing her daughter or grandchildren, likely for years.

Perhaps the most devastating and concise description of BPD comes from Dr. Marsha Linehan, who in addition to developing a treatment for BPD also recently disclosed that she herself has the diagnosis.[iii] Dr. Linehan wrote:

Borderline individuals typically have a limited ability to control their emotions, which, as a result, are volatile in the extreme - volcanic, even. My clients are constantly racked with feelings of self-loathing and shame, fear of abandonment, anger. Imagine navigating life when the most innocent of remarks can provoke paroxysms of despair, crushing shame, or perhaps hyper-exuberant joy. These people are the very definition of severely behaviorally dysfunctional individuals.

[i] American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition. 5th ed. Arlington, VA: American Psychiatric Association; 2013. 663-6.

[ii] Van Gelder, Kiera, The Buddha and the Borderline (New Harbinger Publications, Inc., 2010), 129.

[iii] https://www.nytimes.com/2011/06/23/health/23lives.html