What is Borderline Personality Disorder? A Clinical Psychology Podcast Episode.
In recent years, clinical psychology has undergone a lot of different changes. Some of these changes, like the rise of artificial intelligence, I have kept my eye on but other changes less so. For example, in the past few years, there's been a move within psychology to move away from calling personality disorders, well, personality disorders and towards Complex Emotional Needs. Another change that isn't so recent but it is something that I've started to notice more and more is the label of Borderline Personality Disorder becoming Emotionally Unstable Personality Disorder. These two mental health conditions are the same, and borderline personality disorder is typically the personality disorder that we hear the most about. Yet that doesn't mean that we know what it is in any great depth. As well as people typically know myths and misconceptions about the condition without realizing it. Therefore, in this clinical psychology podcast episode, you'll learn what borderline personality disorder is, what are the symptoms and causes and how it is treated. If you enjoy learning about personality, mental health and psychotherapy, then this will be a great episode for you.
Today's psychology podcast episode has been sponsored by Personality Psychology and Individual Differences. Available from all major eBook retailers and you can order the paperback and hardback copies from Amazon, your local bookstore and local library, if you request it. Also available as an AI-narrated audiobook from selected audiobook platforms and library systems. For example, Kobo, Spotify, Barnes and Noble, Google Play, Overdrive, Baker and Taylor and Bibliotheca.
What is Borderline Personality Disorder?
Borderline Personality Disorder is a chronic mental health condition that can include difficulties with interpersonal relationships, mood instability as well as there are high rates of suicidal and self-injury behaviour. Although, suicide risk is greater in younger adults with the condition and tends to decrease with age.
If a person has the condition then they typically show signs of pervasive instability in their mood, self-image, interpersonal relationships and their behaviour. This behaviour can become problematic to the individual as it leads to disruptions in their family and working life as well as their sense of identity.
Before I explain more about the condition, I want to mention my positionality on this podcast episode. Firstly, I used to be friends with 2 people with Borderline Personality Disorder, and I am no longer friends with them. Reflecting on our relationships, I will admit that their difficulties did make it difficult for us to be friends but equally, I was dealing with my own severe mental health difficulties at the time so this didn't help either. As well as back then, I still had disorganised attachment, so that didn't help either.
Looking back, I clearly made mistakes and I will never pretend that I was perfect. Then again, for reasons that I will explain, Borderline Personality Disorder can make friendships difficult, but not impossible.
There are lots of examples of people having good, fulfilling and positive friendships with those with Borderline Personality Disorder.
In addition, I understand that as an aspiring psychologist, personality disorders represent a large gap in my knowledge base and I would not feel confident working with someone with a personality disorder. In the future, this would change as I learn more and do more podcast episodes like this one, as well as I will hopefully do clinical training over time.
All in all, please understand that these are the points that I am coming from when I write this episode. Reflective practice is always important.
Building upon this, people with Borderline Personality Disorder were originally believed to be on the border of neurosis (defined as excessive and irrational obsession or anxiety) and psychosis (a condition where you lose contact with reality). This is because people with Borderline Personality Disorder struggle with emotional regulation with the condition impacting around 2% of adults.
Furthermore, the condition is more common in women than men with 75% of cases being diagnosed amongst women. As well as people with Borderline Personality Disorder normally need extensive mental health services and they make up 20% of hospitalisations for mental health admissions.
However, it's important to note that with treatment, the majority of people with Borderline Personality Disorder can stabilise and live full and productive lives.
Personally, something that I would like to add here is that from my understanding of treatment for personality disorders, including Borderline Personality Disorder, is definitely a postcode lottery. Since when I used to live down in Canterbury, there was little to no services or provision for people with personality disorders according to various sources. Typically, London was the only place where people could get support. Yet in Medway (about 30 minutes away), there must be some provision or peer support group from what I understand and I've heard.
Yet I do acknowledge that my information about this particular condition comes second-hand from various sources, including people with lived experience.
What Causes Borderline Personality Disorder?
Whilst the cause of Borderline Personality Disorder is unknown, research shows that there are several genetic as well as environmental factors that are believed to play important roles in the development and maintenance of the condition. For example, research shows that a lot of people with Borderline Personality Disorder have a history of neglect, abuse and separation as young children with as many as 40% to 71% of people with the condition having been sexually abused as a child. As well as the condition is 5 times more common amongst people with close relatives with Borderline Personality Disorder as well.
The majority of researchers that focus on Borderline Personality Disorder tend to subscribe to the Diathesis-Stress model. This model proposes that it is the environmental stress, abuse and neglect of the young child that triggers their individual genetic vulnerability to developing Borderline Personality Disorder that triggers the onset of the condition. That is how researchers propose it works for children. Whereas when an adult develops Borderline Personality Disorder, they are significantly more likely to be victims of violent crime and rape.
Personally, all I will say on this research matter is that this is concurrent with what I have observed. The people I have met with Borderline Personality Disorder are unfortunately survivors of rape and sexual trauma as children. Although, it must be noted that just because you are raped or you are a survivor of sexual trauma, it does not mean that you will develop Borderline Personality Disorder. I have been raped as an adult, and I do not have the condition. This strongly suggests that there must be other factors too.
One of these other factors can include neurochemicals because neurochemicals like norepinephrine, serotonin and acetylcholine play a role in regulating our emotions, so there is some research that suggests these chemicals are disrupted or they do not work as typically seen in people without Borderline Personality Disorder. Some evidence for this is the fact that certain drugs that enhance brain serotonin function might improve emotional symptoms within people with Borderline Personality Disorder.
Of course, the issue with this research is very similar to the debunked serotonin hypothesis in depression treatment. You cannot empirically imply that neurochemicals cause a mental health condition just because a drug causes some changes. That is working backwards and that is not science. Real science is you start with a hypothesis, you design an experiment and you work towards drawing a conclusion, and that conclusion is based on your data. Your conclusion of "neurochemicals must cause Borderline Personality Disorder" should not be based on an observation of a change caused by a drug when you haven't even tested a hypothesis to reach that conclusion.
Anyway, if you want to learn more, I highly recommend you look into the history of the serotonin hypothesis and why that is not real science.
If we turn our attention towards neuroscience, then there is evidence that suggests that the mood instability, anger, aggression, impulsivity as well as negative emotions seen in Borderline Personality Disorder might be caused by neurological mechanisms in the brain. In particular, the amygdala, the part of the brain that regulates negative emotions, and in response to a perceived threat, this brain area controls our fear and arousal response. Researchers suggest that the amygdala might be more active in people with Borderline Personality Disorder.
On the other hand, the prefrontal cortex might also be involved in Borderline Personality Disorder because this is the brain region responsible for dampening the activity of the amygdala. Therefore, neuroimaging studies have shown that individual differences in the brain's ability to activate regions in the prefrontal cortex predict a person's ability to suppress negative emotions.
What Are the Symptoms of Borderline Personality Disorder?
For a person to be diagnosed with Borderline Personality Disorder, then they need to have some or all of the following symptoms according to the DSM-5. For example, they need to experience intense bouts of depression, anxiety or anger that might last for a few hours up to a few days. During these times, the person might experience episodes of self-injury, drug or alcohol abuse or impulsive aggression.
In addition, individuals with the condition might make efforts to avoid imagined or real abandonment, recurrent suicidal behaviour, as well as they might have distortions in their sense of self and thoughts that typically lead to frequent changes in their career plans, jobs, identity, values and long-term goals.
Building upon the sense of self point, people with Borderline Personality Disorder sometimes see themselves as fundamentally untrustworthy and bad people. This leads them to feel empty, bored, mistreated, misunderstood and that they have little idea about who they are.
A final major symptom is that they have transient, stress related paranoid thinking or dissociation (meaning that they lose touch with reality).
Personally, before we move on I want to focus on this last point about paranoid thinking. Since one of the difficult aspects about my previous friendship with someone with Borderline Personality Disorder was the paranoid thinking. The core belief that myself or others were out to harm them, get them or make them question their reality even when their claims or beliefs about what happened were unfounded or false as backed up by multiple witnesses.
I will say more but I want to talk about two more important aspects of this condition then I want to reflect and add in some personal thoughts.
Furthermore, individuals with Borderline Personality Disorder typically have highly unstable patterns of relationships because they tend to develop intense but stormy attachments. This causes their attitudes of their friends, family as well as loved ones to change rapidly from idealisation, where the person loves and treasures the other like they are the best thing in the entire world to devaluation. This is an intense dislike and anger towards the other person.
In practice, this can mean that when people with Borderline Personality Disorder form a relationship or friendship with someone then these attachments can be immediate and intense, but when there's a slight conflict or separation between the two, the person with BPD can suddenly switch to the exact opposite and devalue the other person as quickly as they started to idealise them. As well as the person with BPD can accuse the other person of not caring about them at all.
Interestingly, this is where the condition of Borderline Personality Disorder can intersect with insecure attachment styles. Since if we take anxious attachment, people can form very intense and immediate attachments, they can get distressed by conflict and fear of abandonment or rejection. Yet this doesn't mean that they have Borderline Personality Disorder. You would need to have other symptoms of BPD to get a diagnosis.
The reason why this is important to remember is because in my experience, the diagnosis of Borderline Personality Disorder can occasionally be open to abuse. For example, my former emotional abuser kept trying to convince me that I had Borderline Personality Disorder because of my attachment and relationship difficulties. In reality, I had disorganised attachment and their emotional abuse didn't help me either.
Building upon this, most people can tolerate the ambivalence of experiencing two contradictory states at the same time. Whereas for people with Borderline Personality Disorder, they constantly shift between good and bad states without there being an in-between. For example, if they're in a good state then they have no awareness of the bad state.
Moreover, people with the condition are highly sensitive to real or perceived rejection. So much so that even a business trip, going out with other friends and change in plans can cause the person with Borderline Personality Disorder to experience negative feelings, thoughts and behaviours. Such as fears of abandonment. This rejection seems to relate to difficulties feeling emotionally connected to significant friends and family members when they're physically absent so this leaves the person with Borderline Personality Disorder to feel worthless or lost. This links to suicide because suicide threats and attempts might occur alongside the person's anger at the perceived disappointments or abandonment.
How Is Borderline Personality Disorder Treated?
Thankfully, there are a wide range of treatment options available for individuals with Borderline Personality Disorder. For example, psychological therapy, group, family and peer-based support as well as medication.
When it comes to medication, this typically involves drugs that are used to treat specific target symptoms instead of treating the condition as a whole. For example, antipsychotic drugs might be used when there are distortions in a client's thinking whereas antidepressants might be used to manage depressed mood.
On the other hand, group as well as individual psychological therapy have been consistently shown in research to be the most effective form of treatment for Borderline Personality Disorder, and it is the first-line treatment. The types of therapy used include cognitive behavioural therapy, mentalisation-based therapy, psychodynamic therapy and dialectical behavioural therapy.
What Is Dialectical Behavioural Therapy?
I wanted to include this next section because DBT is highly recommended and it is a core part of the treatment of Borderline Personality Disorder, so it's important to be aware of. The rest of this section is a short extract from my book Introduction to Psychotherapies.
Therefore, dialectical behaviour therapy is a manualised and structured form of therapy made up of both weekly individual and group sessions for 6 to 12 months that has a strong educational component (something I am already a fan of) and the therapy aims to give clients the skills to manage intense emotions as well as negotiate social relationships.
Anyway, this therapy was originally developed to prevent the self-destructive impulses of chronically suicidal clients. Yet Dialectical Behaviour Therapy can be used for people with emotional dysregulation, borderline personality disorder and a wide range of mental health conditions.
Now something I have always wanted to know about this therapy is the name, because the name makes no sense at first until you know what “dialectic” means. Therefore, the dialectic part is the therapy acknowledging that all our lives are complex and our health changes over time through a continuous Socratic dialogue with themselves and other people. So the dialectic part is about striking a balance between opposing forces and investigating the truth of our powerful negative emotions.
Additionally, Dialectical Behaviour Therapy acknowledges the need for change in a context of acceptance of our situation and the therapy helps us to recognise the constant influx of all our feelings without letting ourselves get caught up in them. Also, we need to remember that when people experience a lot of intense emotions, they tend to contradict each other so this confuses and distresses a person even more.
On the whole, the therapist helps clients to accept as well as understand that our thoughts are naturally messy and the therapy is an interplay of practice and science.
Clinical Psychology Conclusion
After wondering about borderline personality disorder for years, I’m really happy that we’ve finally managed to learn the truth about the condition. Especially, as borderline personality disorder gets mixed up with other personality disorders, like Multiple Personality Disorder and so on.
And whilst there were times when this podcast episode was more information-heavy, it is still really important that we are aware of this information. Not only because we never know the person who will come through our therapy doors and request support from us, but we also never know the sort of people who we will meet in our personal or professional life. You might make a brilliant friend, they reveal that they have borderline personality disorder and knowing this information will hopefully stop you drawing a lot of false conclusions about your new friend or peer.
As a brief recap, borderline Personality Disorder is a chronic mental health condition that can include difficulties with interpersonal relationships, mood instability as well as there are high rates of suicidal and self-injury behaviour. Although, suicide risk is greater in younger adults with the condition and tends to decrease with age.
If a person has the condition then they typically show signs of pervasive instability in their mood, self-image, interpersonal relationships and their behaviour. This behaviour can become problematic to the individual as it leads to disruptions in their family and working life as well as their sense of identity.
I really hope you enjoyed today’s clinical psychology podcast episode.
If you want to learn more, please check out:
Personality Psychology and Individual Differences. Available from all major eBook retailers and you can order the paperback and hardback copies from Amazon, your local bookstore and local library, if you request it. Also available as an AI-narrated audiobook from selected audiobook platforms and library systems. For example, Kobo, Spotify, Barnes and Noble, Google Play, Overdrive, Baker and Taylor and Bibliotheca.
Have a great day.
Clinical Psychology References and Further Reading
Bozzatello, P., Blua, C., Brandellero, D., Baldassarri, L., Brasso, C., Rocca, P., & Bellino, S. (2024). Gender differences in borderline personality disorder: a narrative review. Frontiers in Psychiatry, 15, 1320546.
Crotty, K., Viswanathan, M., Kennedy, S., Edlund, M. J., Ali, R., Siddiqui, M., ... & Gartlehner, G. (2024). Psychotherapies for the treatment of borderline personality disorder: A systematic review. Journal of Consulting and Clinical Psychology, 92(5), 275.
Jørgensen, M. S., Møller, L., Bo, S., Kongerslev, M., Hastrup, L. H., Chanen, A., ... & Simonsen, E. (2024). The course of borderline personality disorder from adolescence to early adulthood: A 5-year follow-up study. Comprehensive Psychiatry, 132, 152478.
Keepers, G. A., Fochtmann, L. J., Anzia, J. M., Benjamin, S., Lyness, J. M., Mojtabai, R., ... & Medicus, J. (2024). The American Psychiatric Association practice guideline for the treatment of patients with borderline personality disorder. American Journal of Psychiatry, 181(11), 1024-1028.
Leichsenring, F., Fonagy, P., Heim, N., Kernberg, O. F., Leweke, F., Luyten, P., ... & Steinert, C. (2024). Borderline personality disorder: a comprehensive review of diagnosis and clinical presentation, etiology, treatment, and current controversies. World psychiatry, 23(1), 4-25.
Leichsenring, F., Heim, N., Leweke, F., Spitzer, C., Steinert, C., & Kernberg, O. F. (2023). Borderline personality disorder: a review. Jama, 329(8), 670-679.
Mendez-Miller, M., Naccarato, J., & Radico, J. A. (2022). Borderline personality disorder. American family physician, 105(2), 156-161.
Qian, X., Townsend, M. L., Tan, W. J., & Grenyer, B. F. (2022). Sex differences in borderline personality disorder: A scoping review. PloS one, 17(12), e0279015.
I truly hope that you’ve enjoyed this blog post and if you feel like supporting the blog on an ongoing basis and get lots of rewards, then please head to my Patreon page.
However, if want to show one-time support and appreciation, the place to do that is PayPal. If you do that, please include your email address in the notes section, so I can say thank you.
Which I am going to say right now. Thank you!
Click https://www.buymeacoffee.com/connorwhiteley for a one-time bit of support.
Comments