Borderline Personality Disorder
By Michael Hart, M.A, C.C.C, R.P
Approximately 20% of the general population in the United States and Canada will experience a mental illness in their lifetime. According to data compiled by the National Alliance on Mental Illness, NAMI, that number correlates to 43.8 million US Citizens or 1 in 5 adults. According to information on NAMI’s website, between 1.6 to 5.9 % of the population in the United States suffer from Borderline Personality Disorder (BPD) whereas the Canadian Mental Health Association of Canada estimates that, of the general population, 1 to 2% suffers from BPD.
Of the major personality disorders known today, BPD is one of the hardest to diagnose and treat. Commonly thought to be an incurable disorder, BPD is characterized by unstable behavior patterns that traverse a variety of settings. Symptoms of BPD include frantic efforts to avoid perceived abandonment or rejection, inappropriate and intense anger, identity disturbances, unstable self-image, emotional instability and recurrent suicidal behavior.
Risk Factors
Risk factors for developing BPD include genetics and a family history of the disorder; environmental, social, and cultural factors; and brain anatomy and function. While a family history of BPD may increase the risk of developing the disorder, other factors seem to have a more significant influence. The amygdala and the limbic system are responsible for controlling human emotions, while the frontal lobe is where most impulses are controlled. Recent studies have indicated that structural abnormalities in these areas may be contributing factors to the disorder, but questions remain as to whether these abnormalities are the cause of the disorder or caused by the disorder.
Environmental, social, and cultural factors seem to play the most significant factors in BPD. Traumatic childhood events such as abandonment, abuse, hostile conflict, or the absence of validating relationships have been linked to BPD, although, not all individuals experiencing the above will develop BPD. The behavior is divided into four categories to help mental health professionals diagnose BDP: cognition (thinking), affect (feelings), interpersonal functioning, and impulse control. A diagnosis of BPD requires abnormal function in at least two of the four categories.
Symptoms of BPD
Persons with BPD exhibit a pattern of impulsive behaviors. This impulsiveness may lead to repeated acts of risky sexual encounters for some. For others, impulsivity may take the form of overspending, speeding, gambling, drug use, or other actions that negatively impact those with BPD and others they are in a relationship with.
Those with BPD often have the trait of intense emotional reaction which can lead to threats of suicide or even suicide attempts if a love relationship or friendship ends. Not only are their emotions intense but can change drastically from one day to the next. For example, they may speak about a relationship or a friendship being horrible one day and then talk of it in glowing terms a few days later. Their intense emotional reaction does not always take the form of vulnerability in which they self-harm or threaten suicide but can also lead to excessive anger in which they damage the property of others or even physically abuse others.
Many psychotherapists believe that this overreaction may be due to unresolved childhood trauma from such things as abandonment. For example, a person with BPD is not only responding to the current hurt of a friendship that has ended, but the breakup may be triggering the past pain of a parent who abandoned them.
People with BPD often exhibit a very unstable self-image, often dealing in “all good” or “all bad” perceptions of themselves and others. This pattern of thinking can lead to a pattern of broken relationships with others, including in their own family. It is not uncommon for a person with BPD to have family members that they have not spoken to for years because of relatively minor conflicts. The “all bad” perception of self can also lead to sabotaging of relationships with others that mean well because the person with BPD may conclude that some ulterior motive must drive others interest in them.
Effective Treatment Options
Experts agree that the earlier treatment is begun, and continued, the more likely a positive outcome will result. Persons left untreated are prone to develop other chronic medical and mental illnesses and are less likely to make healthy lifestyle changes.
A combination of psychotherapy, utilizing both individual and group therapy, has been shown to help identify the problems. In treating BPD, prescription medication is not generally used. However, it can be a useful tool for dealing with co-occurring mental illnesses such as depression or anxiety.
Dialectical Behavioral Therapy (DBT) and Cognitive Behavioral Therapy (CBT) have shown to be effective in the treatment of BPD. DBT strategies are particularly helpful in teaching BPD clients how to control emotional outbursts and deal with distress in ways that do not lead to other problems. CBT, on the other hand, helps those with BDP by teaching them how to change unhealthy thought patterns and self-destructive behaviors that lead to sadness, depression and other unwanted mood states.
Spirituality and BPD
Some people with BPD, see themselves as unlovable and unpardonable by God, leading to feelings of hopelessness and despair. When God does not answer their prayer in a manner of their choosing, their self-image is negatively affected leaving them feeling unworthy of God’s attention. The concept of a loving and forgiving God who comforts and strengthens during disappointments can be helpful in regulating the volatile emotions of people with BPD.
People with BPD often use their faith beliefs to degrade, manipulate, and control others in their congregation. These tendencies can make it difficult for lay counselors and members of the faith group to help those who are afflicted with the disorder. Faith groups tend to extend love and grace to people with BPD far beyond what they might receive elsewhere. This tolerance can be misinterpreted by those with BPD to mean that inappropriate behavior will be condoned and lead to worsening of their condition. Whether you are a church member, Christian counselor, or someone else interacting with someone who has BPD on a recurring basis, there are several things that should be kept in mind that will significantly increase the chances of managing the disorder more effectively: Firstly, clear, concise, and consistent limits are mandatory. Without these limits, the door to chaos and disorder is swung wide open. Secondly, helping those with BPD to develop a healthy relationship with others who provide them with a safe place to share their emotions can go a far way in promoting emotional stability. This may take the form of a small group setting in which they have come to trust others. Thirdly, it is important to remember that people with BPD have a mental disorder but that a mental disorder is not a blanket excuse for bad behavior. Being loving but firm regarding which behaviors are intolerable and the consequences for engaging in them is necessary if those with BPD are going to start handling their disorder in a functional manner eventually. Fourthly, It is crucial to be aware of manipulating behavior while threats of self-harm should always be taken seriously and every effort made to protect the person, threats should never be used as an escuse for those with BPD to do whatever they want. The “tough love” approach is sometimes the catalyst that leads them to get the professional help that they need.
BPD is a lifelong illness that will require ongoing therapy in one form or another. For the person with BPD, finding a mental health professional that one trusts, one who is knowledgeable about BPD, is a crucial element in managing the disorder.
Sources:
https://cmha.bc.ca/documents/borderline–personality-disorder-2/
https://www.nami.org/Blogs/NAMI-Blog/June-2017/Understanding-Borderline-Personality-Disorder
https://www.nami.org/Learn-More/Mental-Health-By-the-Numbers
https://www.christianitytoday.com/pastors/1989/fall/89l4042.html
