Twenty years ago while I was in the throes of depression, I received a diagnosis of Borderline Personality Disorder (BPD). I was an Educational Psychologist with a Masters in Psychology, and yet, I had never heard of BPD. Not until recently, when I started doing a series of blogs on BPD, had I really come to understand it. I now pat myself on the back for not only surviving, but now thriving, with the disorder. I will always live with some of the symptoms that I will describe in this article, but I have not only discovered how to manage them, but I now realize that I have actually grown into the person I am because of them. I am now living the life I truly love living. In this article I want to let you know what living with BPD is like and perhaps give you a few hints on how to manage it.
First let’s be clear about a few things. “Borderline” does not mean borderline. This is a severe mental condition affecting the lives of millions of people, often leading to suicidal behavior. Secondly, BPD is one of several personality disorders recognized by the DSM 5. Thirdly, BPD was first noted in the 1940’s as a condition between neurotic (the brain) and psychotic (the mind) that could not be treated by medication or traditional therapy.
Now let’s take a look at what BPD is. According to the DSM 5, BPD is defined as impairments in personality (self and interpersonal) and the presence of pathological personality traits. As people with BPD, we may have various combinations of over 20 traits mentioned in the DSM5. It is tempting to form a check list and set a number to establish a criteria for when these traits, or combinations of traits, become a disorder. However, I think one has to work the other way, from the top down, rather than the bottom up, and start with the fact that we may have reached a point in our lives where we can no longer handle the stress of day to day living. This usually results in clinical depression, addictions, and suicidal behavior. Then we can look at the traits that brought us there. The following is a just a portion of the traits that I personally have had to deal with:
- Impoverished or poorly developed self-image including excessive self-criticism
- Chronic feelings of emptiness
- Interpersonal hypersensitivity, often feeling slighted or insulted
- Intense, unstable, and conflicted close relationships , marked by mistrust, neediness
- Preoccupation with real or imagined abandonment;
- Emotions that are easily aroused, intense, and out of proportion to events and circumstances.
- Intense feelings of nervousness, tenseness, or panic;
- Fears of falling apart or losing control.
- Fears of rejection by – and/or separation from – significant others;
- Frequent feelings of being down, miserable, and/or hopeless
- Pervasive shame; feeling of inferior self-worth;
- Thoughts of suicide and suicidal behavior
- Engagement in dangerous, risky, and potentially self-damaging activities, unnecessarily and without regard to consequences with denial of the reality of personal danger.
Quite a list, isn’t it? And there is more where that came from. If you see yourself in this list or if you see someone you love, it is definitely cause for concern. Research suggests various numbers for the prevalence of BPD: however, it appears to be somewhere around five to six percent of the general population. There is a definite correlation with suicidal behavior, particularly involving some of the traits. A study by Kelly et al 1 led to a startling conclusion. Patients diagnosed with BPD who scored low on overall social adjustment, were over 16 times more likely to have attempted suicide than patients diagnosed with major depression. A study conducted by Brodsky et al2 concluded that Impulsivity was the main characteristic that was associated with a higher number of previous suicide attempts. There is also a strong connection with anxiety disorders. Grambalet et al. 3concluded that BPD patients were significantly more likely than the people in the control groups to suffer from a wide range of anxiety disorders including: panic disorder, social phobia, generalized anxiety disorder, mixed anxiety/depression disorder, adjustment disorder, and post-traumatic stress disorder. In addition, one in five patients had two or more of these disorders. And then there is the connection with BPD, anxiety and depression. All these studies indicate that those of us with BPD are significantly at risk. Perhaps the most startling research conclusion was by Black et al (2018)4. They discovered that at least three-quarters of people diagnosed with BPD have attempted suicide, and approximately 10% have died tragically.
In conclusion, if we look at the numbers, we have what might be considered as an epidemic connection among BPD, anxiety disorders, depression, addiction, and suicidal behavior. This could involve up to two million people in Canada alone, with approximately one and a half million of who could have attempted suicide, and about 150,000, of us who may have died because of it. I know this is playing with numbers but regardless of the actual numbers-WE DO HAVE A BIG PROBLEM. If this is not a call to action, I don’t know what is. Where do we start?
- We recognize the breadth and degree of severity of this disorder.
- We invest in saving lives even if it includes a surtax and perhaps proceeds from lotteries.
- We first deal with the Addictions with major changes in policy including decriminalization and increased community support services.
- We need major intervention is suicide prevention and mental health services for people involved is self-harm and high risk behaviors.
- We recognize BPD as a high need element in our mental health policies and services.
- Only then can we begin to treat the symptoms and traits associated with BPD.
1 Thomas M. Kelly, PhD1; Paul H. Soloff, MD1; Kevin G. Lynch, PhD1; Gretchen L. Haas, PhD1; J. John Mann, MD2. Recent Life Events, Social Adjustment, and Suicide Attempts in Patients with Major Depression and Borderline Personality Disorder. Vol. 32, Iss. 6. Dec. 2000.
2 Brodsky, Beth S.; Malone, Kevin M.; Ellis, Steven P.; Dulit, Rebecca A.; and Mann, Hohn J..
Characteristics of Borderline Personality Disorder Associated With Suicidal Behavior. Am J Psychiatry 1997; 154:1715–1719)
3 Grambal, A; Prasko, J; Kamaradove, D; Latalova, K;Holubova, M;Sedlackova,Z.; and Hruby, R.. Quality of life in borderline patients comorbid with anxiety spectrum disorders – a cross-sectional study. Dovepress. 2016.