7 Challenges of Borderline Personality Disorder
Borderline Personality Disorder (BPD) is one of the most complicating disorders for mental health professionals and researchers. Why? BPD is complicated based on many factors such as the environment (i.e, upbringing, influences, etc.), temperament, genetic predisposition, age at which BPD was identified and treated, treatment recommendations, etc. So much goes into identifying, understanding, and coping with BPD. What makes matters more complicated is the unraveling of convoluted symptoms by family, caregivers, friends, and mental health professionals. For example, some individuals with BPD struggle a great deal with being told about their diagnosis by a mental health professional. This may cause the individual, who once idealized their therapist, to devalue, dislike, and disregard them. Another example may include an adolescent with BPD traits expressing suicidal thoughts to his mother while simultaneously appearing to enjoy the attention of the “sick role.”
Treating and helping a loved one with BPD symptoms requires internal strength, patience, and knowledge. This article will highlight 7 challenging characteristics of individuals with BPD. Next week’s article will focus on ways to cope with these 7 characteristics as a friend or family member.
One of my very first clients out of graduate school was a young adolescent who fit the description of BPD 100%. The only reason I could not apply the diagnosis was because she was only 14 years of age. With the collision of adolescent hormones and pressuring peer and school experiences, diagnosis her with BPD may have come across as negligent. So I refrained from diagnosing her. Over the course of 4.5 years I found myself in multiple positions as a mental health professional in school, residential, and hospital settings. During this time I treated, evaluated, supervised, and referred numerous teens fitting the BPD criteria. It wasn’t until 2014 that I met up again with my very first client at the age of 17.5yrs old. She had gotten much worse. Her MO (modus operandi) was to threaten suicide or other types of self-harm, cut herself and gloat among friends about “how deep it was,” and throw tantrums that resulted in multiple trips to the hospital by the police.
I found myself not only shocked but confused at why she had gotten worse after showing such improvement while working with me in 2011. Sadly, she continued to deteriorate and eventually ended up in a residential setting where she would receive 24/7 treatment including daily physical restraints and loads of medications. Aside from daily refusal to bathe, eat, or visit with family, she often refused medication to engage staff in power-struggles and failed to make any lasting connections with those around her. Her BPD was the worst I had ever seen at a professional level.
This experience, including many others, awakened me to the horrifying nature of BPD. Not everyone with BPD fits the above description. But some do. As a result, we need to understand the core “symptoms” of BPD and how to cope with them.
Below are some of the core symptoms of BPD that often confuses family, friends, and even mental health professionals:
- Dysphoria: Dysphoria is a state of general dissatisfaction with life or things around you. It is a depressive-like state that leads to negative self-talk, low self-esteem, feelings of inadequacy, and sometimes confusion over one’s identity. It is a pervasive or chronic feeling that isn’t so easy to “shake off.” For some of my clients, dysphoria feels like a low-grade depression that sticks around no matter what. Nothing seems to pacify the “stubborn nature” of dysphoria. Some individuals abuse alcohol and/or drugs and self-harm to cope with the dysphoria.
2. Attention-seeking, manipulating, or controlling: As I’ve stated multiple times in the past, not all individuals with BPD behave or think the same. Some individuals may come across as manipulative, controlling, or attention-seeking because these behaviors are the only behaviors they believe help them get their needs met. These behaviors may also give a sense of control. For example, someone who fears abandonment may get angry with a friend for no apparent reason but then later call to apologize and set up a dinner date, expecting to get what they want. Manipulative and controlling behaviors may include a teen claiming he/she might kill themselves if the parent does not allow them to date their love interest. But it could also be the only way the teen feels he/she will get the attention needed.3. Emotional chaos and storms: Emotional chaos and storms may include incorrect, skewed, or paranoid thinking patters and emotional reasoning (i.e., rationalizing things based ONLY on emotions without considering the facts). Some individuals with BPD, primarily when stressed, experience paranoid and delusional beliefs. The paranoid and delusional beliefs may not be bizarre but could be understandable and believable. For example, a wife with BPD (while under stress) may believe that her husband is cheating on her with a co-worker because he stays out late and then returns home to text her about work. This is not a bizarre belief but the paranoia and delusional thinking is unsupported by a lack of evidence. The emotional chaos may then create an emotional storm between the married pair and lead to a full-blown argument that just should not have happened at all.4. Internal emptiness and loneliness: One of my very articulate and emotionally astute teen clients told me that they often feel empty and lonely when away from friends because “I have to sit with all of my unresolved emotions, anxious thoughts, and memories of irrational behaviors.” He reported that when with his friends he is able to avoid these things including his chronic feelings of loneliness and emptiness. Despite discussing self-care, using positive coping skills, engaging more frequently with peers and family, finding purpose in an interest, etc., he continued to struggle with internal feelings of emptiness which triggered suicidal thoughts. This typical pattern of behavior (which led to multiple hospitalizations) included: feelings of emptiness/loneliness, risk taking (i.e., drinking, driving fast, sexual experimentation, etc), negative thoughts, negative self-talk, and then cutting with the goal of killing himself.5. Relational chaos: Most individuals with BPD struggle to maintain healthy (and stable) relationships because of intense emotions, emotional neediness, and behaviors that are or come across as manipulating and controlling. Other individuals with BPD simply cannot engage in the “dance” of a reciprocal relationship, especially if the individual is not taking medication or seeking therapy for symptoms. Relationships often feel like a “push-and-pull” pattern. “I hate you-don’t leave me” is a great place to start to help you understand this pattern.6. Denial, anger, and rage: Denial of symptoms, anger around minor things, and rage when triggered are all things that make BPD difficult to deal with and cope with. Many individuals struggle with BPD as a diagnosis. The stigma, the misconceptions, the judgments, the internal fear of oneself are all barriers to acceptance. Without acceptance, the roller-coaster emotions continue.7. Progress and then…deterioration: It is not surprising to mental health professionals who work with BPD that a client may show great improvement and promise and then later show great deterioration. BPD, for someone individuals, can include roller coaster symptoms and emotions that keep them in a perpetual cycle of confusion. This is exactly why many families and caregivers struggle with discouragement about a loved one ever recovering.