Besides Glenn Close, the original bunny boiler in Fatal Attraction, other Hollywood portrayals of Borderline Personality Disorder, or BPD, have included, among others, Kristen Wiig in Welcome To Me and Evan Rachel Wood in Thirteen. But each portrayal is only one view; indeed, with five of nine symptoms required for diagnosis, there are dozens of ways to have BPD (plus, put a Hollywood filter on any psychological disorder and you’ll almost always end up with the funhouse mirror version).
So what exactly is “borderline” about BPD, besides, perhaps, our understanding and portrayals? BPD was originally thought to be “on the border” of a psychotic disorder, like schizophrenia, and a mood disorder, like depression. And while BPD is now an established disorder in its own right, the name has stuck for the millions of Americans it affects.
So if it’s not psychosis and it’s not depression, what is it? Any personality disorder, by definition, is a lens through which you see the world. It’s an ingrained way of thinking and feeling—about yourself, about other people—that affects all domains of life: work, school, social, relationships. And the hallmark for BPD is instability: instability in relationships, identity, and emotion. In other words, its stability lies in its instability.
What exactly does that look like? Look for these nine signs:
Sign #1: Fear of abandonment. Imagine being afraid you’ll be dropped by your partner or friends at any moment. It feels so real and because the idea of being rejected and left is so terrifying, it makes you a little desperate. Little things, like your partner coming home later than expected or a friend rescheduling your coffee date, can make you fly into a jealous rage, stalk them on social media, or cling like a toddler wrapped to mom’s leg on the first day of preschool. You’re convinced they’re leaving you, even when they reassure you—at first patiently, then not so patiently—that they’re not. Ironically, all the freaking out does exactly the opposite of what you’re hoping for: it sends the people you love running for cover (and away from you).
Sign #2: Unstable relationships. Your romantic relationships, friendships, and even family life are intense to say the least. You love them, you hate them. You need them, they’re dead to you. You crave a hug, but warn, “Don’t touch me.” You fall in love quickly and wholly, but things do a 180 just as quickly. It’s whiplash in emotional form. Your life has more passion and conflict than a telenovela. You can sum it up with the phrase, “I Hate You, Don’t Leave Me,” which, incidentally, is not only an impressively perceptive Demi Lovato song, but a useful book about BPD.
Sign #3: Feeling unsure of who you are. Imagine the adolescent search for identity, boiled down into a bouillon cube of angst. You shop around, trying out different jobs, social scenes, religions, lifestyles, sexual identities, groups of friends. Sometimes you feel pretty good, but that can quickly flip to hating yourself or even feeling nonexistent.
Sign #4: “I make bad choices.” Especially when you’re angry, sad, or frustrated, you may find yourself in situations you later regret: spending sprees, epic food binges, shoplifting, drunken benders, sleeping with strangers or toxic exes. It’s a welcome distraction from your pain, but after the dust settle, you’re left feeling crazy, regretful, and out of control.
Sign #5: Maxed-out mood swings. Your emotions are both intense and fragile. It’s hard to break out of feeling sad, angry, or irritable, but you seem to flip from feeling fine to feeling horrible like a light switch. People may comment that the intensity of your reactions doesn’t seem to match the situation at hand. To make matters worse, while others may be able to let problems and hassles slide off their backs, somehow your baggage sticks like glue.
Sign #6: Anger. Your temper is hot, your fuse is short, and your anger is explosive, plus it’s often stronger than the situation warrants. You pick fights, yell, throw dishes, or even throw a punch. But you don’t spare yourself, either—you rage at yourself in addition to everyone else.
Sign #7: Emptiness. You often feel empty inside, like you have no emotions at all. You feel nothing. There is a hole inside you that nothing can fill. Which may lead to…
Sign #8: Self harm. Sometimes you hurt yourself—you cut or burn yourself and find the pain to be a relief. You’d rather feel something—even pain—than nothing at all. Or, you’d rather feel physical pain, which at least you can control, rather than emotional pain.
Sometimes, you might threaten to kill yourself to see if anyone cares, or as the classic cry for help. You might make suicidal-ish gestures like collecting pills. You may even try to kill yourself, but often without an intent to die; rather, you simply want to end this pain and emptiness. And tragically, with some folks with BPD, it works: the suicide rate in BPD is 50 times higher than the general population.
Sign #9: Small departures from reality. When you’re stressed, you may feel numb or dream-like, as if your life is a movie, or that it isn’t real. In addition, you may get a little paranoid, feeling like others are out to get you.
What to do about all this? Luckily, there’s Dialectical Behavior Therapy (DBT), the go-to treatment for BPD. There are four skills. Two of them fall in the “change” camp: first, there’s emotion regulation, otherwise known as being able to work with your emotions rather than just letting them break over you like a wave. Second, there’s what’s called interpersonal effectiveness, or how to ask for what you want, as well as how to say no, while leaving your relationships intact. The other two skills fall in the “acceptance” camp. The third is mindfulness—observing and describing the present moment without trying to change it. The last? Distress tolerance—building up your ability to endure emotion that otherwise might have sent you into a tailspin.
According to the New England Journal of Medicine, effective DBT can reduce hospitalizations as much as 90%, and lead to relapse rates as low as 15%. Indeed, whoever said you can’t change your personality didn’t know about DBT.
If you saw yourself in today’s episode, have hope: change is possible. Seek out treatment with an experienced DBT provider. If you’re worried about affording therapy, don’t be afraid to see a student. He or she will be supervised by a licensed provider, which is like getting two brains in one. They can help you build, as DBT asks you to envision, a life worth living.
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