Borderline Personality Disorder (BPD) is a mental health diagnosis, which, like any diagnosis, emerges from complexities of the human experience. Specifically for BPD, symptoms often arise as a way of coping with the impact of traumatic events. Individuals with BPD feel emotions deeply and intensely, which can be difficult to manage and requires patience and understanding —both for those directly navigating the challenges of BPD and also for their loved ones. Individuals with BPD experience a heightened sensitivity to the environment and interpersonal dynamics, which can lead to profound struggles with self-image and relationships. Intense emotional experiences can be accompanied by challenges in managing feelings and impulses, which can lead to emotional highs and lows.
This article is crafted with a goal of providing insight and aiming to create a compassionate understanding of the lived experiences of individuals with BPD. The article will touch on some of the common experiences of those with BPD, some approaches to managing symptoms, and offer perspective to improve understanding of the diagnostic process.
What is Borderline Personality Disorder?
Individuals navigating life with BPD experience emotions in a way that's distinct from those without this diagnosis. This experience includes difficulty in harnessing coping skills amidst stressful situations, which can lead to emotional turmoil. While everyone finds managing stress and emotions challenging at times, for those with BPD, these challenges are magnified, accompanied by significant emotional distress that might not be as prevalent in individuals without BPD.
At the core of BPD lies a real fear of abandonment and ongoing feelings of loneliness. Such emotional experiences can make accessing effective coping strategies more difficult, often giving rise to feelings of anger, anxiety, and depression, as well as issues concerning self-image and identity. In addition, individuals with BPD are at a heightened vulnerability of experiencing suicidal thoughts or self-harming behaviour. It is essential to approach these experiences with compassion and understanding as there can be a profound impact on daily life and interpersonal relationships for individuals with BPD without the right support and management strategies.
Impact on Daily Life
The following experiences are common for people with BPD:
- Feelings of loneliness and fear of abandonment: Individuals with BPD struggle with chronic feelings of loneliness and a genuine fear of being abandoned by important people in their lives, which can amplify distress reactions.
- Difficulty Managing Emotions: It can be extremely challenging to cope with distress and manage emotional triggers. This struggle can lead to intense bouts of anger, depression, or anxiety.
- Relationship & Interpersonal Struggles : Experiencing intense emotions can translate into protective reactions and emotionally charged actions. The tendency to view concepts as 'black and white' further complicates personal connections, causing perceptions to fluctuate rapidly. These dynamics can contribute to patterns of relationship instability.
- Risk of Harm & Impulsivity: A common aspect of living with BPD is experiencing impulsivity, which can lead someone to engage in high risk behaviours that pose potential harm to themselves.
- Feeling ‘Stuck’: For many with BPD, they have experienced cycles of being in and out of the hospital as a result of ongoing struggles with BPD symptoms, have received a misdiagnosis, or have experienced disconnection with professionals they have worked with. Ongoing situations such as these can contribute to a sense of feeling stuck in their struggles.
- Battling Stigma: Stigma associated with BPD, whether within the medical field or broader societal perceptions compounds challenges of living with BPD. This stigma can contribute to feelings of shame, diminished self-confidence, and a reduced ability to accept one’s diagnosis.
It is important to note, however, that with the right support in place, managing emotions and challenges linked with BPD is possible.
Strategies & Coping Mechanisms
- Seek Support: Finding the right professional to work with who demonstrates a strong understanding of BPD is important. There are specific therapy approaches, like Dialectical Behavioural Therapy (DBT), that can help with gaining understanding of and working through some of the challenges linked to BPD. Attending psychotherapy with a trusted professional can improve coping strategies and guide the establishment of healthy personal and relationship dynamics.
- Education & Awareness: For individuals with BPD, who may feel very disconnected from themselves or others, developing a greater awareness and understanding of thoughts and emotions can be transformative. Education can empower individuals with self-awareness, and is also a first step in improving one’s sense of control, sense of self, and coping strategies. This can be achieved through working with a professional or accessing available resources.
- Engage in Meaningful Activities: “Meaningful” activities will look different for every person, varying from working to meditation. Meaningful activities provide a sense of agency, belonging, and connectedness which allows for self-exploration and reflection.
Understanding the Diagnosis Process
A diagnosis can be helpful for people who believe they have BPD and have difficulty managing symptoms on their own. However, a diagnosis is not mandatory to seek mental health support related to BPD. It is important to determine if pursuing a diagnosis aligns with your mental health needs.The diagnostic process requires people to share emotions, thoughts, reactions, and sometimes challenging life experiences. Making an informed decision about pursuing a diagnosis is essential.
Benefits of a Borderline Personality Disorder Diagnosis:
For those grappling with BPD, a diagnosis can sometimes be a helpful step toward mental health management. Each individual’s journey is unique and not everyone feels a diagnosis is right for them. However if you do choose to pursue a diagnosis, here are some of the benefits to consider:
- Accessing Appropriate Support: A formal diagnosis can sometimes provide an avenue to the proper support systems, including therapists who specialize in working with the BPD population and the exploration of specific medication options.
- Improved Symptom Understanding: A diagnosis can foster an increased understanding and awareness of BPD symptoms increasing one’s ability to manage triggers and symptoms or provide direction in seeking support. This can be a validating experience and help people to conceptualize their experience and acknowledge the need for support.
- Increased Safety & Support: The clarity and understanding that can come from a diagnosis can provide a starting point for holding conversations with trusted individuals in one’s life, which can increase safety and support.
- Consideration of medications: The decision to utilize medication is a personal choice and should be discussed in detail with your physician or psychiatrist. However, having a diagnosis can assist you in facilitating the discussion with your health care provider about the right medication for managing symptoms.
What to Expect in the Diagnostic Process
Obtaining a BPD diagnosis involves providing in-depth information related to emotional management, daily mental health challenges and relationship patterns. Key components of the diagnostic process include:
- Assessment & Clinical Interview: A meeting takes place with a qualified mental health professional (typically a psychologist or psychiatrist) to discuss symptoms of BPD, history and experiences.This can sometimes be followed up with subsequent meetings. The clinical interview is an in-depth discussion delving more into thoughts, emotions, behaviours, and the impact of BPD symptoms on your life.
- Psychometric Testing: Some providers will also use standardized questionnaires as an additional tool of the assessment process, referred to as ‘psychometrics’. The questionnaires are used to gather specific information about symptoms of BPD that cannot always be clearly assessed from just clinical interviews.
- Borderline Personality Disorder and the DSM-5: All diagnoses are made based on specific criteria outlined in the Diagnostic and Statistical Manual of Mental Disorders (DSM-5). The assessing professional compares your information and symptoms against a checklist of criteria outlined in the DSM-5. The criteria in DSM-5 for BPD is related to emotional management, impulsivity, relationship patterns, and suicidal ideation or self harm. The diagnosing professional is guided to consider both a set of symptoms and also the degree of impact that such symptoms have on an individual’s daily life.
- Collaboration: The diagnostic process should be a collaborative approach. It is okay to express your thoughts, ask questions, and advocate if you disagree with something that is being proposed. Upon receiving a diagnosis, you should be provided with proper information and resources about the diagnosis and treatment options.
Preparing for Therapy Services or Diagnosis
- Request a consultation: If possible, research and consult with a few different mental health professionals, specifically those experienced in working with BPD. Determining who you feel most confident in and who you feel most comfortable with is part of making an informed decision about services.
- Take your Time & Ask Questions: Feeling nervous or apprehensive while discussing vulnerable topics is quite normal, so take your time when answering the questions. If at any point you are uncertain about the purpose of a question or how the information will be used, you have every right to seek clarification, and should expect to receive a reasonable response.
- Strongly Consider the Value in a Diagnosis: Take the time to reflect on whether pursuing a diagnosis is the right choice for you. For some, a formal diagnosis is a meaningful part of their mental health journey and aligns with the aforementioned benefits. However, each person’s journey is unique and this is not the case for all. It is also vital to understand that seeking a diagnosis does not guarantee that you will receive that diagnosis, given the specific criteria the diagnosing professional has to consider.
Seeking the right support for Borderline Personality Disorder can be a constructive step in effectively managing your mental health. Psychotherapy and/or diagnosis can provide people with an opportunity for increased understanding of self and access to appropriate support and treatment for BPD, leading to improved coping skills and emotional regulation strategies. If you are wondering whether you or someone you know may be struggling with BPD, don't hesitate to reach out to a mental health professional for guidance and support.
American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). https://doi.org/10.1176/appi.books.9780890425596
Borderline personality disorder. (n.d.). National Institute of Mental Health (NIMH). https://www.nimh.nih.gov/health/topics/borderline-personality-disorder
Biskin, R., & Paris, J. (2012). Diagnosing borderline personality disorder. Canadian Medical Association Journal (as cited in the National Library of Medicine). https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3494330/
Centre for Addictions and Mental Health. (2009). Borderline personality disorder: An information guide for families. https://www.camh.ca/-/media/files/guides-and-publications/borderline-guide-en.pdf
Centre for Addictions and Mental Health. (n.d.). Personality Disorders. CAMH. https://www.camh.ca/en/health-info/mental-illness-and-addiction-index/personality-disorders
Ng, F. Y., Townsend, M. L., Miller, C. E., Jewell, M., & Grenyer, B. F. (2019). The lived experience of recovery in borderline personality disorder: a qualitative study. Borderline personality disorder and emotion dysregulation, 6, 1-9. https://doi.org/10.1186/s40479-019-0107-2