Do you know someone who is struggling with intense emotions, rage or anger, emotional lability, interpersonal conflict, unstable social or family relationships, and poor self-image? If so, perhaps you are dealing with Borderline Personality Disorder (BPD). BPD is a mental health condition that affects all facets of a sufferer’s life. Sadly, although BPD has become less stigmatized over time (especially with Dr. Marsha Linehan and many other experts educating society, families, caregivers, and sufferers to what BPD actually is), it is still hard for people to accept. But as a mental health therapist I have evaluated, talked to, and counseled adolescent girls who stayed in multiple abusive and emotionally unstable relationships for the simple fact that “I cannot live without him. I will die.” These intense emotions led to a cascade of other behaviors that were disturbing such as stalking, obsession, begging, and even sexual immorality. The intensity of the emotions of someone suffering from BPD may be disproportionate to the actual situation. My experience with clients has been that a diagnosis of BPD is like a death sentence due to stigma. This article will explain what a diagnosis of BPD can lead to and how to view the diagnosis in a healthier way.
As a therapist there are times when I have trouble sharing a diagnosis with a client. Why? Because so many of the mental health diagnoses that society talks about (depression, anxiety, bipolar disorder, borderline personality disorder, narcissism, psychotic disorders, and sociopaths) are all stigmatized and confused by hearsay, incorrect information on the Internet or in society, and hidden by those too embarrassed to discuss it. It’s no wonder so many people would rather not see mental health professionals. Receiving a mental health diagnosis or personality disorder diagnosis can change your life forever. Not just change the course of your life due to symptoms, but also change your social, work, and familial relationships in addition to how you view yourself. Self-esteem is often at the core of someone’s difficulty in accepting a mental health diagnosis. It’s bad enough that many of us struggle with self-esteem and incorrect perceptions of ourselves, much less trying to function confidently in the world with a mental health or personality diagnosis.
Over the course of my career I have seen my fair share of clients drop out of therapy after a mental health or personality related diagnosis. Some of the most stigmatized diagnoses included schizophrenia or some other disorder with psychotic features, borderline, antisocial, and narcissistic personality disorder, and oppositional defiant disorder and conduct disorder (which often can develop into sociopathy later in life). In fact, a previous adolescent client ran out of my office when I shared with she and her mother what my case conceptualization was. I informed the young lady and her parents that she was meeting criteria for borderline personality traits and that borderline personality disorder may be a future diagnosis. The young lady bolted out of my office door and ran to the car. She eventually returned after 35 min and shared that she was ashamed that she had “a diagnosis of someone who is really crazy.”
- It can open the door for specialized treatment: Individuals diagnosed with BPD should not be so concerned about the label and the stigmatized information found online or spoken in the community. But individuals with BPD should be focused on the fact that treatment can be more tailored to the specific symptoms and challenges that often creates interpersonal, emotional, and psychological barriers. For example, a good therapist will seek to place the individual diagnosed with BPD in a DBT (Dialectical Behavior Therapy) group or program or include DBT work within the therapeutic relationship to help the individual cope and grow in treatment. The label does not have to be a “death sentence” but rather the beginning of a therapeutic plan designed specifically for the problematic symptoms.
- Exploration of the diagnosis can lead to greater understanding: Finally receiving a diagnosis of BPD can truly lead to relief, even if that relief is only psychological. Some of my long-term clients have expressed how grateful they were for finally getting the correct diagnosis. Feeling like you are hanging in mid-air just waiting for some kind of understanding of what you are suffering from, can feel like a slow death. Having a label that makes sense, has a specific treatment plan, and has an evidence-based (proven to work) treatment plan can take a load of stress of your shoulders.
- BPD can help you identify the “why” of intense emotions & conflict: As stated above, being able to understand what a label means can be a load off. Many individuals who are struggling with BPD symptoms such as: intense emotional reactions, fear of abandonment, poor self-image, and lack of identity are often glad to finally understand “why” they have been suffering within their social and interpersonal relationships for many years. Because of the constant challenges within relationships of all kind, the individual with BPD may begin to attribute the relational difficulties to how they were raised, to the culture they were born into, or a problem with morals, ethics, or values. Having a label disrupts this incorrect view.
- BPD is more than a label: Although BPD is just a label, having the label can help those around you including your own therapist understand how to help and support you.
- Medication management can begin with a goal to target the right symptoms: Medication management is often important if depression, anxiety, or psychotic symptoms are present. Although medication cannot “cure” BPD, it can reduce symptoms such as depression or anxiety that contribute to self-injurious behaviors, suicidal thoughts, or depressed and anxious mood. If psychotic symptoms are present (paranoia, hallucinations, delusions, etc.), medication can help stabilize the individual so that therapy can be more effective.
- The roller coaster relationships can stop: It is a known fact that individuals with BPD struggle within their relationships. A typical case of BPD may include multiple or vicious divorces, multiple partners over time, abusive behaviors and/or domestic violence (male or female), anger management difficulties within the community, obsessive or paranoid behaviors within a romantic relationship, and even stalking if the obsessive relational patterns get worse over time. With a label of BPD and appropriate treatment, the individual can better understand why their relationships tend to be chaotic or unstable. While BPD is not always the reason for stormy relationships, for those with the diagnosis, remaining in therapy to work on relationship stability is an important step toward building healthier relationships.
- You can begin researching ways to help yourself: When you don’t know exactly what you are struggling with it can feel almost impossible to figure out how to help yourself. For example, if you don’t know that your symptoms of isolation, anhedonia, lack of motivation, and tearfulness or irritability are signs of depression, you can become very confused if you look your symptoms up online or talk to others you may trust. It can be difficult for mental health professionals and even medical professionals to narrow down your symptoms enough to provide a diagnosis, much less you and those around you. Going to Webmd, Mayo Clinic, or some other website can confuse you more than you were before. Having the label first and then researching it can make all the difference.
- Your family/friends/caregivers can better assist you: Being able to share a label with your loved ones can truly awaken them to what you are experiencing. It’s like telling your loved ones you have cancer or heart disease. They will know (or learn) how to help support you and may even begin to educate themselves to how you are affected on a daily basis. Your loved ones may even come up with ways to help you cope.
- You will know how to identify your triggers: Having a label can help you not only educate yourself and others to your needs, but also help you identify your triggers. For example, for individuals suffering from BPD, a trigger is often the fear of abandonment within relationships. Knowing that you exhibit symptoms characteristic of BPD can help you identify the things that make you feel vulnerable within your relationships. You can also learn about the things that can lead to relational challenges that completely break you down emotionally.
What has been your experience with BPD or with someone who has BPD? What was the response after getting the diagnosis? Do you think people have a negative view of BPD? Why is it so hard for some individuals to accept the diagnosis?
As always, feel free to share your thoughts below.
-Tamara Hill, MS, LPC