Receiving a diagnosis of borderline personality disorder (BPD) may seem devastating. There’s a lot of confusion about what BPD really means and how it’s actually treated. Along with misunderstanding, there’s also stigma. This can make a person feel even more alone. However, BPD actually affects about two% of the population. That’s more people than have bipolar disorder or schizophrenia. And there’s good news: Borderline personality disorder is treatable and recovery is possible. But with so many misconceptions out there, it can be hard to know the truth about BPD and just how hard it can be to live with it. So let’s talk about a few of them…
Individuals with BPD are manipulative
BPD is the result of a combination of causes, including biological factors and a history of being invalidated, which may result in an inability to regulate emotions, according to Michael Baugh, LCSW, an expert in dialectical behaviour therapy (DBT) and mindfulness at Third Wave Behavioral Center, his private practice in Seattle. Picture a bell curve of emotionality, Baugh suggested. “Individuals at the more emotional end of the spectrum (like people with BPD and many good therapists) are more easily and strongly triggered by events in their environment, and it takes longer for them to return to baseline — but they can learn the skills to manage these more intense emotions,” he said.
Baugh gave the following example: An emotional child grows up in a stoic family, where he’s constantly told to calm down. He tries to follow the family’s rules by suppressing the awareness of his emotions. As the intensity of his emotions ramps up, however, it eventually bursts out of the zone where they can be ignored. When this happens, the emotions appear to go from zero to 60 on the emotions speedway, and their intensity can’t be controlled. “At that point, everybody in the family has to deal with it, and because people need to have emotions responded to, this only reinforces the person getting too emotional extremes,” Baugh said. Consequently, this becomes the only way the person knows how to manage emotional situations.
In other words, a person with borderline personality disorder rarely makes a conscious decision to manipulate anyone. When a person isn’t having their needs met, they resort to extreme behaviours, according to Neil Bockian, Ph.D, founder and president of Behavioral Health Associates and co-author of New Hope For People with Borderline Personality Disorder. These behaviours then get reinforced when family members or people who don’t normally pay attention to them rush in, he said. When loved ones get burned out, the person with BPD starts escalating the behaviours.
“The research shows convincingly that some treatments for BPD are remarkably effective,” said Kristalyn Salters-Pedneault, Ph.D, a clinical psychologist who specializes in BPD and writes a blog on About.com on the disorder.
BPD is a life sentence
According to Alexander Chapman, Ph.D, president of the DBT Centre of Vancouver and co-author of The Borderline Personality Disorder Survival Guide: “In a recent study of patients with BPD who were hospitalized and then released, up to 70% no longer met criteria for the disorder at some point in a six-year follow-up period. Of those people who stopped meeting criteria for the disorder, 94% of them never met criteria again across the six years.”
People with BPD aren’t trying hard enough
According to Joan Wheelis, M.D., director of the Two Brattle Center in Cambridge, Mass., “it isn’t that clients aren’t motivated, but that there is significant emotional, cognitive and behavioural dysregulation associated with the disorder.” People don’t realize just how considerable their deficits are. Many are very intelligent, talented and productive so it’s hard to believe, she said. “The person is doing the best they can given their current mental state,” Bockian said.
Unfortunately, it’s not uncommon for people with BPD to refuse treatment. Many don’t think they have a problem. They may believe that this is who they are and that everything would be fixed if others reacted to them the way they’d like, Bockian said. “But treatment does work with whoever is motivated to seek it” he said. It is clear that living with BPD is no easy at all and there are many misconceptions out there. But there is help and advice to be found if you are willing to seek it.