“It’s not something I have, it’s something I am.”
That’s how Rebecca Bunch, a character on the CW’s Crazy Ex-Girlfriend, played by Rachel Bloom, described herself after being diagnosed with borderline personality disorder on the show.
That hasn’t been the only mention of BPD in pop culture recently. In May, Saturday Night Live‘s Pete Davidson took to Instagram Stories to talk about his own experience with BPD—and how, contrary to what some of his critics think, those with borderline personality disorder can maintain successful relationships.
“Just because someone has a mental illness does not mean they can’t be happy and in a relationship,” he wrote. “It also doesn’t mean that person makes the relationship toxic. I just think it’s f*cked up to stigmatize people as crazy and say that they are unable to do stuff that anyone can do. It’s not their fault and it’s the wrong way for people to look at things.”
Still, borderline personality disorder is spoken about less than other mental illnesses like anxiety and depression, which might leave you wondering, What is BPD in the first place—and is it possible that I have it?
What is borderline personality disorder?
Borderline personality disorder (BPD) is a mental health condition that is “marked by an ongoing pattern of varying moods, self-image, and behavior,” according to the National Institute of Mental Health (NIMH).
A key characteristic of BPD—and a key diagnosing criteria for the disorder in The Diagnostic and Statistical Manual of Mental Disorders (DSM-5)—is impulsivity, as well as issues with maintaining personal and professional relationships, says Mayra Mendez, Ph.D., a licensed psychotherapist and program coordinator for intellectual and developmental disabilities and mental health services at Providence Saint John’s Child and Family Development Center.
An estimated 1.6 percent of the U.S. population has BPD, per NAMI.
People with BPD will have trouble functioning as a result of their personality, and may often display unstable and unhealthy behaviors, says Mendez.
Those unstable and unhealthy behaviors, in turn, affect all aspects of a person’s life with BPD, says Mendez, as those with the disorder tend to struggle with self-image, and have a hard time defining their own sense of self.
Their personal perceived inadequacies also spill over into their relationships: “If they can’t live with themselves, then they can’t live with others very well,” says Mendez,
What are the symptoms of BPD?
Expect that a person with borderline personality disorder will have a point of view that involves extremes—often resulting in intense mood swings, Mendez says.
“One day you are all good to them and the next day you’re their worst enemy,” she explains. “These are pervasive patterns, meaning they are always there. They don’t play out better with one person more than another.”
Nearly 75 percent of people diagnosed with BPD are women, per NAMI.
It’s also common for people with borderline personality disorder to frequently question how they see themselves, making them quick to change their interests and values, according to NIMH. Substance abuse and self-harming behavior are common, as is dissociation (the feeling of being cut off from yourself, or seeing yourself outside of your own body). People with BPD also frequently experience difficulty trusting others and inappropriate, intense bursts of anger.
Mendez says interactions within relationships are typically a tell-all for whether or not a person is dealing with BPD. “When they start to relate to someone, they either idealize them—they’re over the top—or they destroy them because they no longer fit their idealistic perspective or perception,” she says.
BPD can also show some of the same symptoms as depression, according to the National Alliance on Mental Health—including self-harming behaviors, recurring thoughts of suicidal behaviors or threats, and chronic feelings of emptiness
But there’s one big difference between depression and BPD: “Depression is reality-based and borderline personality disorder is about perception,” says Mendez. Basically, while a person with depression might be affected by situational things that are actually happening in their lives, a person with BPD is reacting to how they perceive things to be. That means that something like, for instance, a friend not answering their phone call, could lead a person with BPD to believe there is a larger issue at hand—when in reality, there’s not.
What causes BPD?
Experts don’t know for sure what causes BPD, but many believe that a variety of factors can increase your risk, including genetics, brain structure (typically in areas of the brain that control impulses and emotional regulation), and even environmental, cultural, and social factors (like traumatic events during childhood), per the NIMH.
Of course, those risk factors don’t mean you absolutely will develop BPD—and there’s also a chance of developing BPD without any of those risk factors, per the NIMH.
What does treatment look like for BPD?
Mendez points out that it can be “tricky” for a person with borderline personality disorder to identify their symptoms, which then makes it difficult to diagnose and treat them. A person with BPD might also struggle to maintain a patient-doctor relationship for the same reasons they do other relationships, forcing them to cycle through many psychologists without finding one that fits, says Mendez.
“What tends to happen is that when things start to go sour, a person with borderline personality disorder will start to feel very empty and feel like people aren’t worth keeping in their lives because they’re not feeling satisfied,” she says. “And it’s just a vicious circle.”
But treatment is possible with regular support from a mental health professional, Mendez says. Treatment options include cognitive behavioral therapy (CBT), as well as dialectical behavior therapy (DBT), which teaches people with BPD how to better control their intense emotions and reduce self-destructive behaviors.
“Treatment isn’t going to shift the personality style,” Mendez says. “What treatment can do is help the person think about where they have their greatest challenges, and look at patterns of behavior to see what they lead to and what they mean.”
In addition to psychotherapy, medication may also help with BPD symptoms, per NAMI—antidepressants, for example, may help with mood swings, while low-dose antipsychotic medications may help with disorganized thinking.
Overall, if you think you might have BPD, and it’s affecting your life and relationships, it’s important to talk to a licensed mental health professional—like a psychologist, psychiatrist, or clinical social worker—to find the best treatment option for you.
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