22Apr
There are many misconceptions about borderline. First of all, 'the Borderliner' does not exist; there are different degrees, and it occurs in both sexes. People often tend to label difficult women as Borderliners, just as difficult men in a relationship are often labeled as narcissistic.
This generalization causes some people to be saddled with a stigma, when they are merely clear, dominant, contrary, or explosive. So where exactly does the boundary lie between a mental disorder and a character trait?
Back to Borderline. Most people are aware of fluctuating moods, an unstructured life, sexual promiscuity, substance abuse, difficulty with social interactions, and self-mutilation up to and including suicide. But is that really the case? In a previous article, I already wrote about the similarities and differences between BPD and Bipolar Disorder.
A Borderliner can manifest in two forms (and, of course, a large gray area in between): the expressive and the introverted. In these extremes, the more introverted Borderliners are harder to recognize. They, too, experience fluctuating moods, ranging from extreme energy to total despondency and depression, but because they rarely express themselves, this inner person is less noticeable.
The name Borderline literally translates to 'boundary line'. It was previously assumed that the disorder lay in the area between neurosis and psychosis, but this view has changed—although the name has persisted. Within psychiatry, there are calls to change the name, for example to Emotion Regulation Disorder (ERD) or a similar name, because the term borderline is unclear.
So what exactly is it?
I would like to point out the following personality traits:
-A low sense of self-worth.
-Tendency toward self-harming behavior (self-mutilation, for example, deliberately cutting or burning oneself), sometimes also in combination with manipulation.
-Concealing insecurity through provocative behavior.
-Tendency toward extreme (pre)judgments. For example: in relationships with friends and/or partners, it is often all or nothing – often everything first, and then suddenly nothing.
-Dissociation: people with borderline personality disorder can occasionally be absent, no longer in reality for a certain period of time. It then seems as if they are watching themselves acting in a movie. Dissociation is an escape mechanism to keep emotions under control. It usually occurs when stress becomes too much.
-Separation anxiety, the fear of being abandoned.
-Feelings of loneliness, even in a group.
-Self-destructive behavior and impulsivity, for example, promiscuous sexual partners, substance abuse, or shoplifting.
-Identity problems: failing to develop an 'I' or 'self'.
-Borderline personality disorder can coexist with brief psychoses (from a few hours to a few days).
There are many tests available on the internet where you need to score 6 out of 10 items for a BPD diagnosis. But how objective is that?
The most well-known form is the impulsive, extroverted Borderliner (F60.30 in the ICD-10): emotional instability, poor impulse control, emotional outbursts. The other (F60.31): emotional instability, negative self-image, feelings of emptiness, unstable relationships, fear of abandonment, self-destructive behavior. These two can also occur in combination. Currently, as many as 5 forms of BPD can be distinguished.
Can anyone get it? There is a higher chance of developing this disorder due to traumatic childhood experiences, such as an unstable family situation, sexual abuse, and emotional or physical neglect. Research has shown that 70% of patients have experienced this. The so-called attachment disorders that arise from this lay the foundation for BPD.
In addition, heredity plays a role. The first signs of BPD usually surface during adolescence. In women, we see an increase in traumas resulting from entering a first romantic relationship, and Borderline becomes more manifest.
Unlike other depression and mood disorders, most medication is largely ineffective, partly due to the erratic nature of the condition. One week life is absolutely great, and the next day everything in their lives is terrible. I have patients in my care who struggle with these fluctuations within just a few hours.
It is highly recommended to seek help if you suspect BPD. Weekly talk therapy sessions (Dialectical Behavioral Therapy, shortly DBT) can help keep the patient within a manageable structure, unravel their negative thoughts, and transform negative perceptions into a more positive outlook on life. In my practice, I prefer not to support this group with medication, but rather with alternative solutions focusing on dopamine-boosting nutrition, regulated sleep patterns, and exercise combined with yoga/meditation exercises for home use.
The question they ask me often: can it be cured? My honest answer is: no. It will always remain a part of your personality that you have developed over the years. However, you can learn how to make it manageable and keep it that way. The support of dialectical behavior therapy remains a necessary form of feedback, ensuring that the patient in question can rely on mental health care at our clinic over the years.
What can you do for someone with BPD in your family?
First of all: Keep a delicate balance between compassion and maintaining your own boundaries. The focus should be on creating a stable environment where your loved one feels safe, while ensuring you don't burn out yourself.
-Validate feelings: Acknowledge your loved one's emotions without necessarily agreeing with their behavior or version of the facts. For example, say: "I can see this is very painful for you." This helps calm their emotional system.
-Set clear boundaries: Boundaries are essential for both your well-being and the patient’s safety. Be specific and consistent, e.g., "I cannot talk while you are shouting; I will come back in half an hour to discuss this calmly."
-Stay calm and consistent: Try not to react emotionally to emotional outbursts. A calm, predictable presence helps reduce their fear of abandonment.
-Identify triggers: During calm moments, talk about situations that trigger intense emotions. Understanding the "why" behind the behavior makes it easier to respond with patience.
-Encourage professional help: BPD is treatable, especially through therapies like Dialectical Behavior Therapy (DBT). Support their treatment plan without taking full responsibility for their recovery.
Here some tips how to handle episodes: don't take spoken words too literally. Listen to the underlying pain or fear rather than arguing over accusations they blame you for. Use the STOP sign rule: When tension rises: take a step back and use the words like: let's take a time out, and proceed mindfully. It is crucial that you don’t let the disorder consume your entire life and find your own support: people you trust, can relate your sorrows and will understand your feelings. And remain your social life: Keep seeing friends and pursuing your hobbies to recharge.
Do you have doubts about whether you have Borderline Personality Disorder or dealing with someone suffering it? Then be welcome to talk with us (physical or online). You can make an appointment via 01070806656/01036542739 (call or WhatsApp) or via our website.
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