Little do people know about Borderline Personality disorder. In fact, it is often mistaken with other mental illness such as depressive disorders and bipolar disorder, leaving people suffering from BPD confused, lonely and hard to deal with, taking into consideration that they already are struggling to form any kind of relation with anyone.

Do you think you have met a borderline in your daily life?

“X” is your friend since forever and you seem to have a great relationship with him, but one day he starts pushing you away and accusing you to be unfaithful only for coming back a while later with all his guards down, taking the blame, desperately clinging onto you and declaring you as his one and only friend…and the scenario repeats itself.

Borderlines are walking paradoxes. Their inconstancy is a major reason why the mental health profession has had such difficulty defining a uniform set of criteria for the illness.

Symptoms can be categorized in four primary groups according to the treatment with an overall nine symptoms, five of which should be presented in order to diagnose a person with BPD. The symptoms may appear unrelated, but looking deeper in each of them, we can see how highly connected they are as each symptom sparks another.

• Mood instability:

1. Frantic efforts to avoid real or imagined abandonment.
2. Severe mood shifts and extreme reactivity to situational stresses.
3. Chronic feelings of emptiness.
4. Frequent and inappropriate displays of anger.

• Impulsivity and dangerous uncontrolled behavior:

1. Impulsiveness in potentially self-damaging behaviors, such as substance abuse, sex, shoplifting, reckless driving, binge eating.
2. Recurrent suicidal threats or gestures, or self-mutilating behaviors.

• Interpersonal psychopathology:

1. Unstable and intense interpersonal relationships.
2. Lack of clear sense of identity.

• Distortions of thought and perception:

1. Transient, stress-related feelings of unreality or paranoia.

They say you have to walk a mile in someone’s shoes to even begin to understand life from his perspective. Well, with borderlines, it is never a straight road. You need to go through an emotional rollercoaster with thoughts flaring around embracing all the contradictions along the way. One moment you are thriving with joy, the other you’re falling into a never-ending hole of depression. You start your morning with a cup of coffee so calm and stable, only to burst into tears and screams pushing the loved ones away from you, and since the borderlines has no gray area; only black and white, good and evil, with no cognitive understanding of others’ behavior, then you’ll banish who you once considered an “idol”. Or else, you will banish yourself to maintain the “All Good” image of the other.

Not to mention the loss of identity; it seems like all you have has turned into dust that you don’t even know who you are anymore and here starts the quest searching for a character, shifting from one to another but none will ever suit you. You go too far with that quest only to find yourself so hollow and empty, the feelings of shame starts to surface, guilt paved his way inside you without you even noticing. Everyone is looking at you as a burden, right? You need to compensate for that void…Alcohol? Drugs? Self-harm? Eating marathons? Anorexic fasts? Sexual promiscuity? … SUICIDE??

He may attempt suicide, often not with the intent to die but to feel something, to confirm he is alive.

“I hate the way I feel. When I think about suicide, it seems so tempting, so inviting. Sometimes it’s the only thing I relate to. It is difficult not to want to hurt myself. It’s like, if I hurt myself, the fear and pain will go away.”

Now to understand where all this came from, three theories are up for debate:

• Developmental (Psychological) roots:

This theory focuses on the interaction between the child and the caregivers especially during the first few years of the child’s life.

• Constitutional (Biological and genetic) origins:

Studies has shown that first-degree relatives of borderlines are more likely to show personality disorders than the general public. It is not likely that one gene provokes BPD, but many chromosomal loci are activated probably influenced by environmental factors.

• Environmental and Sociocultural factors:

We need to go way back for this one; alcoholism, drug abuse and violence within the household, divorced parents, traumas, heartbreak, and many other social situations that may provoke a personality disorder.

Dealing with a borderline can be extremely frustrating, that is pretty understandable taking into consideration the sudden outbursts, the mood swings, the shifts in personality, the rage episodes, and the self-destructive acts. For that, a simple method was developed to communicate with borderlines; the SET-UP system which refers to Support, Empathy, Truth, Understanding and Perseverance, all of which should be handled delicately and thoroughly or else there will be a void in the communication process. For example; if you only show support and give the truth, the response will be “You do not know how I feel”. Needless to mention how important it is not to mistake Empathy with Sympathy; with Empathy do NOT use the pronoun “I” because the emphasis is on the other’s feelings not yours.

Since this article is designed to put BPD under the spotlight and raise awareness of this issue, we will not be talking about medical treatment but you can find all the information you need on this topic in the reference. It is still not clear whether the number of patients is increasing or it is the therapists’ awareness of the disorder. After all, by exploring the depth and boundaries of this disorder, we may be facing up to our ugliest instincts and our highest potential, and the hard road we must travel to get from one point to the other.

“All is caprice. They love without measure those whom they will soon hate without reason.”

—Thomas Sydenham, seventeenth-century English physician, on “hystericks,” the equivalent of today’s borderline personality disorder.

REFERENCE:

I HATE YOU, DON’T LEAVE ME; understanding the borderline personality, Jerold J. Kreisman, MD, and Hal Straus.