BPD has been one of my most researched topics and I feel it is rather intriguing and vastly misunderstood by many. My goal for the reader is to allow those who may not be familiar with this topic to be able to gain some insight and compassion-driven understanding about BPD. When we allow ourselves to become more informed about the individual and their experiences, then we can better provide space for non-judgmental and empathy driven support and care.

BPD can be a bit tricky, so I am going to provide you with the essentials of this mental health issue and hopefully provide you with a greater understanding of this particular mental illness so you that you may be inspired to learn more and be more open-minded and thoughtful towards those who live with BPD.

So, if you’re curious to better understand BPD let’s wonder wisely together.

The DSM-V criteria for BPD (301.83) is as follows:

• Desperate attempts to avoid abandonment (real or imagined)

• Unstable interpersonal (social) relationships of extremes (idealizing and devaluating)

• Unstable self-image or sense of self

• Impulsivity which is damaging in at least two areas (sex, drinking, drug abuse,              spending, binge eating)

• Suicidal behavior (threats included), self-mutilation

• Affective (emotion) instability, highly reactive moods

• Feelings of emptiness

• Intense anger, inability to control anger (any opportunity to fight, they will)

• Paranoia and dissociation

This may seem like an intimidating list, but where our focus should lie is removing our own biased fears from the more important task of understanding where these feelings and behaviors stem from. When we are able to view the individual as someone with unique experiences which have created their perspective, then it is easier for us to approach them with the care and empathy.

It is also of import to know that not all symptoms are present simultaneously, not always.

When trying to understand the recurrent symptoms of BPD it may help to think of a tv or radio station. A song or show may be on which they perceive as or is a threat to their safety and with a press of a button or a tune of the dial (changing environment or interaction), they instantly have another song/show (emotion, founded in aggression) being implemented.

BPD has its foundations in disorganized attachment.

When we are very young and learning the world around us our attachment to our primary care-giver is beyond important. If our reoccurring experiences are either interpreted as negative or just plain abusive and neglectful then their brain’s chemistry is altered to accommodate their perceived or real environment. This frazzled network in the brain is preventative to having and maintaining healthy relationships (in love, on the clock, or friendships).

It is their disorganized attachment to those around them facilitating their behaviors. This disorganized attachment creates aggression in both interpersonal and intrapersonal relationships, both public and private. Their emotions can run hot or cold, so please listen to them with patience. Do your best to provide them with positive interactions to draw from, this will help them to begin to form positive relationships with not only you, but others as well.

BPD is an attachment dilemma being reinforced with every negative interaction, real or perceived by the experiencer. BPD can manifest in several differing ways (or not at all because the human brain is an enigma in and of itself, always remember that).

BPD can reveal itself through one or a combination of the following:

• Genetic predisposition (5 times more likely when first-degree biological relatives           have BPD)

• Environment (violent, unstable)

• Abuse/neglect (physical, verbal, emotional, sexual)

BPD tends to go greatly underdiagnosed due to caregivers either being unaware of the symptoms of BPD, the fear and stigma of mental health issues, denial of its existence, viewing it as “going through a stage,” or as normal teenage behavior.

However, the symptoms of BPD are intense, unpredictable, unstable, and cause concerning. These descriptions of BPD are not meant to be a scare tactic but as  informative examples of behavior.

BPD has been greatly studied by many, but Otto F. Kernberg is my go-to for education and a more profound understanding of the disorder. Kernberg and his fellow researchers have devised treatment specifically for BPD (which has also been found to be helpful with narcissistic personality disorder) (NPD).

Kernberg’s Transference-focused psychotherapy (TFP) has been shown to greatly diminish and in some advanced studies deplete symptoms altogether. Seeking a TFP trained psychotherapist would be most beneficial (I’ve done the research), but improvement can be achieved with a non-specialty therapist as well.

When we seek to better understand those with mental health issues, curiosity and compassion is such a great starting point. And, like so many other topics there is far more to learn beyond this little write-up.

If you feel you or someone you know may have BPD, please seek appropriate mental health care.

Remember, for the best information on any topic seek reliable sources. Science-driven articles, websites, books, journals, and peer-reviewed research papers should be your go-to.

Better days can be on the horizon. BPD can be treated through therapy, medication, and familial support. You or your loved one do not have to suffer through.

All my best,

Tricia Rembold

Great sources for more information or assistance:

American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). https://doi.org/10.1176/appi.books.9780890425596

Levy, K.L., Clarkin, J.F., Yeomans, F.E., Scott, L.N., Wasserman, R.H., & Kernberg, O.F. (2006). The mechanisms of change in the treatment of borderline personality disorder with transference focused psychotherapy. Journal of Clinical Psychology, 62(4), 481-502.

Kernberg, O. F., Yeomans, F. E., Clarkin, J. F., & Levy, K. N. (2008). Transference focused psychotherapy: Overview and update. International Journal of Psychoanalysis(89) p. 601-620.

Kernberg, O. F. (1976). Object relations theory and clinical psychotherapy. New York: Jason Aronson.

Doering, S., Hörz, S., Rentrop, M., Fischer-Kern, M., Schuster, P., Benecke, C., Buchheim, A., Martius, P., & Buchheim, P. (2010). Transference-focused psychotherapy v. treatment by community psychotherapists for borderline personality disorder: Randomised controlled trial. The British Journal of Psychiatry(196) p. 389-395.

Bowlby, J. (1988). A secure base: Parent-child attachment and healthy human development. New York: Basic Books.

Call the NAMI Helpline at 800-950-NAMI Or in a crisis, text “NAMI” to 741741