Borderline Personality Disorder is Confusing to Everyone – Including the Patient

Let me begin by saying that if you have this disorder, stop reading right now.  It is much more important that you follow the directions of your mental health professional than read a blog which might be confusing. We are going to talk in generalities about this disorder.  It may or may not match your symptoms or your experience.  You are the expert of your life, so don’t let anything you read here upset or confuse you.

Borderline Personality Disorder is a much misunderstood disorder.  It is confusing and hard to diagnose.  No one really knows what causes it, although some specialists feel that it might arise in a confluence of circumstances which include some or all of the following:

  • Abandonment in childhood or adolescence
  • Disrupted family life
  • Poor communication in the family
  • Sexual abuse

There is a higher prevalence in women and among hospitalized psychiatric patients. See http://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0001931/

There are only two diagnostic criteria in the DSM-V: significant impairments in personality functioning and pathological personality traits.  These have multiple sub-heading and limiters, so be sure to check out this site for complete information:

But of course, nothing in psychiatry is simple.

People with this disorder may be uncertain about their identity. Imagine not being sure who you are and what you stand for.  Your interests may change quickly. And this is combined with an ‘all or nothing’ view of the world. A friend is a saint one day and a bum the next. A husband is a kind loving partner tonight and an abusive SOB tomorrow. Of course, this makes it very difficult for them to maintain relationships.

Ironically, in the midst of these rapid and wide changes of opinion and behavior, the person with Borderline Personality Disorder has frequent displays of overwhelming anger.  While getting mad at the world and everyone in it, they are equally terrified of being abandoned – they behave in a way that causes their greatest fear to be made real. And they have a real, intense, and almost overwhelming fear of being alone.

If you consider that what you value today can be the opposite of what you value tomorrow, it is easy to see a cascading waterfall of problems.  Sexual behavior will not be consistent; use of money will swing from frugality to licentiousness. Extreme dieting to binge eating. Rigid honesty to brazen theft.

And overlaying all those behavior problems is a pattern of self-abuse and self-harm including cutting and overdosing.

As with any disorder, the degree of impairment and the prognosis for successful treatment vary by individual. But treatment is critical since extremes in behavior are their norm, making relationships with others and themselves very difficult. For some, the disorder is life threatening.

One example: An individual came to me because he was upset with his wife but was confused. They had a large family of small children and his wife had been feeling overwhelmed and needy of adult companionship. They agreed she should go out one night a week and chose Wednesday. After a couple of weeks, she didn’t come home.  When she arrived in the morning, they discussed it and she had a good reason for her behavior. The overnighters continued, even though he didn’t like it, but she always arrived on time for him to get to work. A few weeks pass and they’re settling into this new ‘normal’ routine when she comes home on Thursday morning in hysterical grief.

Once he got her calmed down, she disclosed that she’s upset because her boyfriend died.  Needless to say, he’s devastated and starts yelling at her that she can’t have a boyfriend because she’s married to him.

She replies: “Isn’t that just like you. Everything has to be about you and your rules.” And without another word, she walked out, never to return to see him or the children again.

He was confused about his role in their altercation and what to do about the future.

This is an extreme example of the behavior of a woman with BPD. But it shows the changing values, the changing sexual standards, the inability to be alone and the fear of rejection.

And yes, his behavior was normal, considering the circumstances.

The next post will look at treatment modalities and outcomes.  While this disorder seems overwhelming, there are some excellent results being obtained from a combination of therapies.

What do you think? Know anyone with this confusing illness?  Please share your experience but remember no diagnosing yourself or others.

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About Louise Behiel

Author, coach, therapist, mother and grandmother. I'm on a spiritual journey and consciously work to grow every day.
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35 Responses to Borderline Personality Disorder is Confusing to Everyone – Including the Patient

  1. Joan Leacott says:

    The poor guy! His response was perfectly normal. But what an awesome idea for a back story! Are writers awful?

  2. iamnotshe says:

    Lots of bulimics are invinced they are BPD. I ask my therapist this. We’ve decided I don’t fit. However I’m looking forward to reading more because, as you say, it is. Ery confusing and can fit ( or seems like it can fit ) other illnesses. Good preface to this post!!!

    • iamnotshe says:

      Convinced … I’m on my effing phone:)

      • with personality disorders, there are many overlaps of symptoms across the spectrum and with other problems, like eating disorders, so it’s important to let someone who knows you make the diagnosis. ironically the best treatment for BPD is mindfulness – a meditation practice and a way of life, which you can incorporate on your own.

  3. Veronica Roth says:

    Oh Louise, it’s shocking to be in a relationship with a person like the woman you describe. Let’s hope her husband and his chidren get on with their lives.

  4. Louise, those stories are heartbreaking. Thank you for shedding some light on those issues.

    • thanks for stopping by FAbio. 10% of us will be hospitalized for a mental illness, 20% of us will have a serious illness in our lifetime. it’s time to start talking about it.

  5. Coleen Patrick says:

    a saint one day and a bum the next–this sums it up for the experiences I’ve had with a person I’ve been told has this disorder. It’s impossible to have a consistent or even normal relationship.
    Thanks for the info Louise! As always, love these posts.

  6. Stacy Green says:

    Wow on your example. That is just amazing. That poor husband. A very scary illness and much more extreme than I realized. Thanks so much for explaining this to us, Louise.

  7. Count me among the confused… and thanks for clearing up a bit of it. And LOL at Joan’s comment – I was thi.king the same thing!

  8. The husband in your example reacted better than I probably would have had my spouse been staying out all night and then announced he had a girlfriend.
    This sounds like an extremely complicated disorder. The description fits someone in my life (or at least she was in my life until she decided one day to make a complete U-turn and change her entire life, including hurting all the people who cared about her). Unfortunately, she won’t go to counseling so there’s absolutely no way to tell if she really has a disorder or not.

    • Yeah, me too, Marcy. I’m not as nice, or as easy going as he is. and yes, borderline is very complicated. It messes up lives all around – imagine the children in my example for although mom left, what kind of love and care had she been giving to them before this? emotionally barren homes do such damage.

  9. I’ve worked with and known a few people with borderline—definitely complex. Such a blessing that awareness, study and hard work of professionals has led to effective treatment options. Thanks for educating us all on another important topic!

  10. Wow, that poor man. No wonder he was confused. I’ve neve knowingly run into anyone with this disorder, so I find this post not only interesting but very enlightening. Thanks, Louise!

  11. Wow, those are some scary extremes. That poor man. I hope he eventually found a new normal and was able to live a happy life with a more stable partner. This does make for fascinating character studies for our writing. I’m going to have to remember this for the future.

  12. I read this and was wondering how you know what our family friend goes through with his wife. Of course it’s not him, but the story is eerily too close to what he has endured. Now to gently share this with him.
    Can a spouse be considered an enabler if they won’t insist that the one with the illness receive proper help?

    • This example is the type of behavior common to many families with Borderline Personality Disorder. Gentle sharing might be helpful. As far as the enabling goes, I never diagnose others – it takes a great deal of information to help someone find their truth. It also carries its own risks – people with personality disorders have been known to react unpredictably to pressure. And of course there’s always the truth that if I don’t think there’s anything wrong with me, no amount of ‘help’ will make any difference.

      thanks for caring for your friend. If his wife does have Borderline, he needs lots of loving support.

  13. I have BPD and it is VERY painful. I’m high functioning but cannot have normal relationships, although I yearn for one. I’m also a mother which makes it hard on my teenage girl. There is no DBT available in my area making it very frustrating. Prayer helps me lots but I do need some professional help a.s.a.p. Thanks for the article! 🙂

    • From my clients, I understand that Prayer and mindfulness meditation are helpful. Good for you for knowing what is helpful for you. I am sorry for your pain. BPD is a difficult disorder to deal with and you are wise to recognize that and to know the challenges for your daughter. Take care of yourself. I’m glad you enjoyed this post.

  14. Heidi says:

    Ahh. Very good example you gave. Thank you for prefacing this one like you did. We cannot protect people from what they do with information, but we can anticipate it and I liked how you started the post. The info is very good. Thanks for the brief, interesting profile. Good job, again!

  15. I guess we writers are horrible as I was thinking the same as Joan. LOL On a serious note though, it’s so awful that your client and the children had to go through that. And it’s just as sad for someone to have to live with that disorder. Just heartbreaking all the way around.

  16. it is a most distressing disorder, isn’t it?

  17. Buddhist meditation is helpful for BPDs if there is no DBT around. In a pinch those in rural areas can use the Feel Good books by Dr. David Burns. CBT works – maybe not as well as DBT – but it works. BPD is sometimes confused with bipolar disorder and sometimes there are co-morbid issues with BPD/bi-polar or BPD/NPD or BPD/OCD. I had a adult child diagnosed with BPD. She was re-diagnosed with bipolar and OCD. As far as I am concerned the jury is still out. OTOH, I don’t care about the label, I care about the results. Despite the swath of destruction they leave behind them, I feel sorry for them – they suffer greatly. We believe my dad was BPD as well as bipolar and it was hell to be him – as well as hell to live with him. There is a good book by Randi Kreger (sp) called Stop Walking on Eggshells for those really interested in BPD.

    • yes, dialected therapy is wonderful for Borderline treatment. I’ll post a bit about that on thursday. Randi’s book is excellent. I haven’t read it for a long time but I recall it was about re-claiming our lives, if we live with or around someone with BPD. thanks for the reminder.

  18. Lara Britt says:

    A therapist friend of mine lamented that all too frequently people are misdiagnosed with this disorder because they suffered from all or many of the “causes.” He was saying that it is clearly a revictimization of the abused. Aren’t they doing away with this diagnosis in the new guidelines?

    • actually the DSM V is getting rid of many personality disorders but not this one…it’s staying as one of 6 personality disorders. I have not had the experience of your friend. More often people with this diagnosis that I’ve met did not meet any of the ’causes’ but had the disorder. it’s a difficult one, to be certain. we know so little about any of these disorders, really. it’s amazing how the diagnostic criteria change with each version of the DSM.

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