15 facts you need to know about Borderline Personality Disorder
Tags: Trauma, Bpd, Mental Health, Borderline Personality, PTSD

Individuals with BPD can make a full recover

In 2011, eminent psychiatrist Dr John Gunderson published the findings of 10 year longitudinal study. The results were startling, 85% of BPD individuals experience full symptomatic remission. In 2018 another prominent researcher Mary C. Zanarini published her book “In the Fullness of Time”: Even with her strict criteria of recovery — good social life, work and a long term relationship — at sixteen years 60% had got better. Recovery is difficult but not impossible. BPD has a good prognosis

The word Borderline is outdated

Coined in 1938 by American psychiatrist Dr Adolph Stern to describe patients who were neither neurotic or psychotic but on the “border line,” Stern decided that since this group of patients couldn’t be analysed they must be untreatable. Even couched in the prurient lexicon of early 20th century psychoanalysis, Stern was astute in defining symptoms: Narcissism, psychic bleeding, inordinate sensitivity, masochism, anxiety, low self-esteem, and paranoia but wrong in suggesting BPD was untreatable.

BPD has a convoluted history

First appearing in DSM III in 1980, Borderline Personality disorder has had several prior incarnations including Borderland Insanity, Hysteroid Disorder, Extractive Disorder, the ‘As if’ Personality, Psuedoneurotic Schizophrenia, and Ambulatory Schizophrenia. Even, now some people prefer Emotionally Unstable Personality Disorder or Emotional Intensity Disorder as a label. While Stern created ‘border line’ it’s clear the diagnosis has been around for a long time, and will be with us a long time yet to come.

BPD and PTSD are two labels for the same condition

70% of individuals with BPD have a history of chronic interpersonal trauma. Trauma is in fact so prevalent in the case histories of people with BPD some researchers want to rename it Complex Post-traumatic Stress Disorder (Herman, 1992) or Developmental Trauma Disorder,(Van der Kolk, 2005). Because the “disorder” to the personality occurs in the context of early childhood psychological injury, many argue the two labels are synonymous.

You may have inherited the illness

While no one knows which genes are implicated, twin studies suggest the risk of inheriting BPD is between 20–60%. The candidate gene most implicated in the condition is the Serotonin gene 5-HTT. Research remains inconclusive.

Your brain is different from “ordinary” brains.

The advent of MRI technology has revealed that BPD brains are different from the rest of the population. The brain’s emotional control centre – the limbic system — in BPD patients is completely dysfunctional. Significant components of this, including the amygdala — the part of the brain which controls fear and aggression — is overactive, while the prefrontal cortex — the part of the brain set to reason — is underactive. Many of the symptoms including emotional instability, and behavioural instability, can be attributed to these recognisable differences. Thankfully Neuroplasticity means brains can repair themselves; this means symptoms reduce, life get’s better.

There’s more of us than you think

Over 1% of the population has Borderline Personality Disorder, and as of 2019, we are not afraid of speaking out. Several celebrities have spoken openly about their struggle with the condition; the most well known being SNL comedian Pete Davidson and former Miami Dolphins wide-receiver Brandon Marshall. Angelina Jolie also has it, and although we can’t prove it, past dignitaries of the condition probably include the romantic poet Samuel Taylor Coleridge, the artist Vincent Van Gogh, and Princess Diana.

Borderline personality disorder costs millions.

A 1986 UK study concluded that patients with BPD cost the NHS around £61.2 million per year; a figure that over the course of three decades would have risen exponentially. A more recent study in Germany cited the figure of €3.5 billion, and €2.2 billion in the Netherlands. Unfortunately, the cost reflects the lack of services; with little or no specialist treatment, service-users often end up detained, arrested, or in and out of A&E inevitably costing more. Treating BPD is cost-effective, but it’s also the right thing to do.

Therapy works

Evidence-based treatment including Dialectical Behaviour Therapy (DBT [Linehan, 1993]), Schema-Focused Therapy (SFT [Young, 1994]) Mentalisation Based Treatment (MBT [Fonagy, 2004])) and Transference Based Psychotherapy (TFP [Kernberg, 2006])) have all yielded positive results. The most extensively studied, is also the first: DBT was created by Dr Marsha Linehan, who in 2010 revealed that she too, as an adolescent had Borderline Personality Disorder. Stuck in a mental hospital in Connecticut she vowed once she got better, she’d go back and rescue others.

The Bio-psycho-social theory explains why you have this illness.

While the cause of BPD is unknown, over the last several decades, several theories have been put forward. In 1975, American psychodynamic psychiatrist Dr Otto Kernberg argued BPD (or ‘Borderline Personality Organisation’ as he called it) is predicated on the defence mechanism of splitting: The marked idealisation and devaluation of self and other. Whether this propensity to split the world into black and white, may be a constitutional defect, or the result of early infant excess frustration with reality remains to be seen, either way it’s the reason BPD is such a problem. American Behaviourist Dr Marsha Linehan on the other hand, argues a genetic predisposition to sensitivity ricocheting off an invalidating environment leads to overwhelming emotional, behavioural, cognitive dysregulation and subsequent poor sense of self, which as a result create the Borderline construct. Finally, more recently British psychodynamic psychologist Peter Fonagy of the Anna Freud Centre in London, has provided empirical evidence that BPD is formed out of failed attachment and poor mother-infant bonding. What begins as a problem with mirroring (reflecting each other’s bodily intimations) leads to a wider failure of mentalisation (being unable to understand self and other in terms of thoughts, motives and emotions) and this eventually leads to an adult becoming unwell.

Medication doesn’t work

There is no strong evidence medication is helpful in treating borderline personality disorder. Some drugs may be used to target specific symptoms. Carbamazepine, Topiramate and lamotrigine; but even then the results aren’t exactly stunning. Furthermore, many are off-license, meaning they are used by the doctors own discretion, or predilection.

Self-destruction is our “behavioural speciality”

10% of individuals with BPD kill themselves, 70% have attempted suicide, 90% have self harmed. A sobering statistic, and one which should refute allegations of “manipulation” and “attention seeking” once and for all.

You’re not paranoid, clinicians don’t like us.

Borderline Personality Disorder, is sometimes considered an iatrogenic illness meaning “bought forth by the healer.” Poor diagnostics, inappropriate treatment and treatment inaccessibility, means individuals with the condition often find themselves, spiralling into a deeper crisis than when they first presented looking for help. Furthermore, studies which began with ‘Lewis and Appleby (1988)’ and extending to the present day, demonstrably prove clinicians stigmatise and discriminate against us regurarly.

We have a special month to generate awareness.

On April 1, 2008, the U.S. House of Representatives passed, by a vote of 414–0, supporting the resolution to grant the month of May as Borderline Personality Disorder Awareness Month. Such a recognition affords us the opportunity to be activists; furthermore when combined with the stellar work of the NEA-BPD and other organisations, we can promote change.

If you have Borderline Personality Disorder, you are more than the diagnosis.

BPD is a serious mental health problem, however due to the outdated label, we tend to think we have a lifelong character problem. Quite the opposite: When you achieve symptom remission and eventual recovery you’ll discover who you really are: The kind sensitive good person who was there all along.