Understanding borderline personality disorder

Borderline personality order (BPD) is a mental health condition that causes distress to the person who lives with it and those around them. It results in long-term patterns of unstable or explosive emotions that cause impulsivity, self-image issues, and chaotic relationships.

Imagine that you’re secretly afraid and convinced that everyone you love will leave you. Now, imagine that no matter how hard you try, your behaviour inevitably pushes them away, leaving you in the very situation you feared. This is the reality facing people living with borderline personality disorder.

What is borderline personality disorder?

Daleen Macklin, a clinical psychologist who practices at Mediclinic Denmar Mental Health Services, explains that borderline personality disorder is characterised by a rigid, set way of interacting with friends, family and the world around you. “People with this condition are not easily adaptable; they cannot change their behaviour to suit a specific situation.”

Naturally, this type of inflexibility can lead to enormous personal conflict. “In psychology, we talk of ‘splitting’; a phenomenon where people insist on seeing their world and their experiences in it in black and white. However, this means that your view of what is happening or has happened becomes distorted.”

Take this example: you’ve walked into a room, where you see an acquaintance. Although you wait for them to greet you, they carry on talking to other people. Eventually, you give up on them, deciding they’re obviously not worth your energy and vow never to speak to them again.

Someone in a balanced frame of mind would consider that there may be several reasons why their friend didn’t acknowledge them: They may have been caught up in conversation; perhaps they’d had a bad day and didn’t have the mental energy to focus on more than one thing; or maybe they simply didn’t see you.

Emotional fallout from borderline personality disorder

The fact that people with BPD refuse to consider such probabilities means they typically behave erratically and swing between extreme emotions and behaviours. “They might love you one day, then get angered by something you said and dislike you so intensely that it’s as though their previous fondness never existed,” Macklin says.

These emotional fluctuations are very difficult for people on the receiving end and make the individual highly unpredictable. Being around them can cause real distress, especially for children. If the person behaving in this manner is a parent, the child will work very hard to understand the mood, trying to mould their own behaviour so as not to trigger an episode.

This may continue into adulthood as BPD often develops out of a traumatic relationship with a primary caregiver; many patients mimic the likes and dislikes of others, both to make themselves more likable and because they lack a sense of self. This may arise if a child felt they must please a parent, who would withdraw emotionally from time to time. The experience leaves them with a deep craving for affection, coupled with a fear that their loved one will take it away at any minute.

Sadly, though, the fear of rejection that drives these erratic responses often becomes a self-fulfilling prophecy as people push them away to avoid their confusing moods.

Treatment for borderline personality disorder

“Borderline personality disorder can be difficult to treat because it’s often confused with bipolar mood disorder,” Macklin explains. These conditions share some symptoms, such as mood swings and emotional instability, for example.

People usually seek help when their relationships have broken down irreparably. Treatment may come in the form of dialectic behaviour therapy (DBT), an offshoot of cognitive behaviour therapy (CBT), which helps the patient to replace their distorted thoughts with more realistic ones. DBT teaches the individual skills to control their emotions, manage distress, and improve their relationships.

Psychodynamic therapy is another approach, where the therapist will uncover the underlying cause of the disorder and help the patient to work through it.

All methods have merit, Macklin says, so the specific therapeutic approach is less important than the fact that the individual seeks treatment. That said, the process is bound to be complex, because it’s inevitable that the patient will behave with their therapist as they do with everyone else in their life; pushing them away, while secretly wanting their approval.

“It’s vital to keep going despite any challenges because one of the dangers of borderline personality disorder is that it can cause the patient to self-harm. Their desire to be loved is so strong that their experience of rejection may lead to self-destructive behaviour like cutting, burning, pulling out hair and risky sex.”

A psychiatrist may sometimes prescribe medication to help with symptoms like depression and anxiety, and the individual will also be encouraged to adopt a healthy lifestyle with good nutrition, healthy sleep patterns, and regular exercise.

To find a mental health professional near you, visit www.mediclinic.co.za