Borderline Personality Disorder Is Misunderstood By Most, Judged By The Ignorant And Stigmatized Even By Doctors

So, educate yourself, and others, and learn not everyone with BPD is the monster you think

Jul 16, 2024

a person wearing a mask — Photo by Bruno Guerrero on Unsplash

The DSM-V lists ten specific personality disorders: paranoid, schizoid, schizotypal, antisocial, borderline, histrionic, narcissistic, avoidant, dependent, and obsessive-compulsive.

The Nine DSM-V Criteria For Borderline Personality Disorder

According to the Fifth Edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-V), for a diagnosis of borderline personality disorder to be made, patients must have “A persistent pattern of unstable relationships, self-image, and emotions (i.e., emotional dysregulation) and pronounced impulsivity.”

To be diagnosed with BPD according to the DSM-V, five or more of the following nine criteria need to be present:

“Desperate efforts to avoid abandonment (actual or imagined)”
“Unstable, intense relationships that alternate between idealizing and devaluing the other person” — sometimes
“An unstable self-image or sense of self”
“Impulsivity in more than two areas that could harm themselves (e.g., unsafe sex, binge eating, reckless driving)”
“Repeated suicidal behavior and/or gestures or threats or self-mutilation”
“Rapid changes in mood, lasting usually only a few hours and rarely more than a few days”
“Persistent feelings of emptiness”
“Inappropriately intense anger or problems controlling anger”
“Temporary paranoid thoughts or severe dissociative symptoms triggered by stress”

In addition, symptoms must have begun by early adulthood but can develop during adolescence, or later.

They persistently view themselves or others in unrealistic ways
They experience inappropriate thoughts or behavior they won’t change despite the negative consequences of their behavior
They are distressed by their behavior and/or its consequences or cannot function properly, because of their behavior and/or its consequences

The inappropriate thoughts and behaviors may involve how people see and understand themselves and others, their interactions with others, and how well they control their impulses. Such thoughts and behaviors are considered a disorder only when they are constant, yet the individual continues doing them despite the individual’s distress or difficulties in their daily functioning.

BPD can be diagnosed based on the individual’s negative self-image, insecure and unstable relationship, and oversensitivity to rejection and abandonment not present in mood or anxiety disorders.

I was only diagnosed with BPD in my early 40s, but I met five of the nine criteria as a young woman; desperate attempts to avoid abandonment, having no stable sense of identity, rapid mood changes which usually last a few hours, and rarely more than a few days, leaving the person constantly feeling empty, having inappropriate bouts of anger the individual has trouble controlling, and temporary paranoid thoughts.

I had a negative self-image due to years of verbal, emotional, physical, and mental abuse, and emotional with feelings of rejection and abandonment (ex: if my friends didn’t invite me out with them, I would be devastated, if my call wasn’t returned I thought the person hated me, or if my family ignored me, I felt they no longer loved me.

There’s also a constant need for reassurance present in BPD - the reassurance of love, reassurance of friendship, and reassurance others cared about me.

Borderline Personality Can Be Often Misdiagnosed

My previous psychiatrists should diagnosed me correctly more than 20 years ago, but instead diagnosed me with Bipolar Disorder II.

BPD symptoms include significant changes in the person’s mood and behavior. But, in BPD, the changes in mood and behavior occur rapidly in response to triggering stressors, especially interpersonal stressors, not usually lasting very long.

However, in bipolar disorder, the differences in the person’s mood last longer, will not change as often, and there is a significant increase or decrease in the person’s activity and energy levels.

Several disorders that could be an alternative diagnosis of BPD are often also present in the patient, including:

In addition to my BPD, doctors have diagnosed me with Dysthymia (“Depressed mood for most of the day, for more days than not, as indicated by either subjective account or observation by others, for at least two years”) with major depressive episodes, Generalized Anxiety Disorder (GAD), difficulty sleeping, and traits of Avoidant and Adjustment Personality Disorder. I also smoke marijuana, which is legal here, as an alternative to taking extra benzodiazepines, considered narcotics by the government that are highly addictive.

Borderline Personality Disorder is often diagnosed with other mental illnesses at the same time, such as:

Depression
Alcohol or other substance misuse
Anxiety disorders
Eating disorders
Bipolar disorder
Post-traumatic stress disorder (PTSD)
Attention-deficit/hyperactivity disorder (ADHD)
Other personality disorders
Other personality disorder traits
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The Cluster Of Personality Disorders To Which BPD Belongs

Ten personality disorders are listed in the DSM-V, divided into three clusters:

Cluster A is characterized by appearing strange or eccentric and includes Paranoid, Schizoid, and Schizotypal personality disorders.

Cluster B is characterized by seeming dramatic, emotional, or erratic and includes Antisocial, Borderline, Histrionic, and Narcissistic personality disorders.

Cluster C is characterized by coming across as fearful or anxious and includes Avoidant, Dependent, and Obsessive-Compulsive personality disorders.

My BPD started to emerge when I was a teenager, but no one — not my family, not my friends, and not my General Practitioner — noticed anything amiss. They just assumed I had an attitude problem, was rebelling against my parent’s overly strict rules, and I took after my father. His personality and behavior were the same as mine. But given I act the same way he did before dying, there’s a high probability my father had mental health issues. He knew nothing about mental illness and, even after I was (mis)diagnosed by a psychiatrist, refused to accept I was sick or make any effort to understand my diagnosis.

When I acted up, my mother’s favorite expression was, “You’re your father’s daughter.” I responded the same way every time saying, “Good to know you didn’t sleep with the mailman.” I’ll never know if my dad had BPD or any other mental health issues; he passed away in 2003.

Treatment of Personality Disorders

Psychotherapy (both individual and group) is how personality disorders are treated, but therapy is only likely to work if the patient wants the help and wants to change. Psychotherapy can help people understand how their personality disorder relates to their current problems. It can also help people learn new and better ways of interacting and coping. Usually, change is gradual.

There is no medication for personality disorders; the medication can only aid in alleviating co-existing mental illnesses such as depression and anxiety.

Some medications reduce certain personality disorder traits, such as aggression, but there is no cure for personality disorders.

Although specific treatments differ according to the type of personality disorder, treatment, often “Dialectical Behavioral Therapy (DBT),” in general, aims to:

Reduce distress
Help people understand that their problems are internal (not caused by other people or situations)
Decrease maladaptive and socially undesirable behavior
Modify the personality traits that are causing difficulties

Changes in behavior are most important for people with one of the following personality disorders:

Many doctors refuse to work with patients who have personality because they are so challenging to treat, so it’s essential to find an experienced therapist who can handle treating personality disorders, is non-judgemental, and understands the patient’s level of self-image, sensitive areas, and typical coping mechanisms.

When I overdosed in June 2018, in one of my conscious, lucid moments, I distinctly remember one of the doctors who worked to save my life saying to another, in front of me, thinking I was too out of it to understand, “I fucking hate treating personality disorders."

If doctors stigmatize personality disorders, especially Borderline, then what hope do the mentally ill have of eradicating the extreme stigma surrounding mental illness, especially all personality disorders?

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