by Shelia R. Wadsworth, BA
Mental health disorders are common health concerns in the United States today. Some individuals suffer disabling effects from severe mental illness. According to the National Institute for Mental Health website (n.d.), serious mental illness can be characterized by (a) mental, emotional, or behavioral disorders; (b) current (within the year) diagnosis; (c) meeting diagnostic criteria of the DSM-5; and (d) results in significant impairment of daily living. Borderline personality disorder (BPD) is a severe mental health issue which has detrimental impact on an individual, as well as those around him or her. In this piece, I would like to share a little bit about BPD from a professional, as well as personal, perspective.
The Diagnostic and Statistical Manual of Mental Health Disorders (5th ed., 2013) (DSM-5), is the manual utilized by professionals in the mental health field to assist in making diagnostic decisions and as a tool to guide treatment planning. All personality disorders are characterized by a pervasive, rigid pattern of behaviors and experiences which digresses from the typical expectations of his/her culture. The DSM-5 organizes personality disorders into three “clusters” (A, B, C).
BPD is categorized along with antisocial, narcissistic and histrionic personality disorders in cluster B by the DSM-5. BPD is an all-encompassing instability in the person’s self-image, interpersonal relationships and emotion regulation, as well as impulsivity, and typically begins in the teen years or early adulthood. A person with BPD lacks self-esteem and does not have a clear understanding of his/her own direction in life. There are often dramatic changes in opinions, goals, or values. They characteristically view themselves as being “bad” or unworthy especially when they are feeling unconnected with or unsupported by others.
In terms of relationships, an individual with BPD will form attachments very quickly and will expect the other person to devote all of his/her time to them and can be extremely demanding. S/he can be very caring and nurturing but with the expectation that the other person will reciprocate. Relationships with a BPD person are volatile and he/she will vacillate between believing significant people are “all good” (idealizing) or “all bad” (devaluing). They view all situations in terms of “black/white” and that there are no gray areas.
These individuals have a difficult time regulating emotions and will show severe instability of mood with respect to anxiety or irritability with periods of anger, dread or hopelessness but rarely experiences times of well-being or contentment. They have an intense fear of abandonment and will act out in an attempt to avoid perceived or real abandonment. For example, when a loved one must leave (e.g. go to work or on vacation) or there are unexpected changes in plans, they will display inappropriate anger or panic because they perceive this separation as “abandonment” and internalize it to mean that they are a bad person. Frequently, they will resort to self-inflicted injury or suicidal gestures in order to gain the sympathies of significant others. Due to these attempts, BPD is one of the most lethal mental health disorders with 10%, or one in ten, ending in successful suicide (BPD Resource Center website, n.d.). Furthermore, the success rate of females with BPD is 800 times higher than that of the general population.
Often, they display impulsive, self-destructive behaviors such as promiscuous sexual relations, overspending, alcohol/substance use, or binge eating. Moreover, when they begin to show improvement or come close to completing a goal, they will sabotage their own efforts. For example, they will drop out of school just before graduation. As you can expect, it can be difficult living with someone with BPD.
Who is Diagnosed and Why
According to the DSM-5 and the BPD Resource Center, BPD occurs more frequently in females (75%-90%) than in males and can be observed within a variety of cultures. In addition to that, it is estimated that about 2% of the general population, 10% of the outpatient mental health population, and 20% the inpatient population is afflicted. Of all the personality disorders, BPD makes up about 30%-60% of all patients. It is believed that exposure to long-term, traumatic events, such as repeated sexual abuse or violence in childhood, is one underlying factor in the development of BPD.
Co-occurring Disorders and Treatment
Co-occurring disorders, or dual disorders, is a technical term used in the mental health profession to describe when an individual suffers from several psychiatric disorders including depression, anxiety, schizophrenia, or a personality disorder, just to name a few (Daley and Moss, 2002). As discussed earlier, BPD individuals frequently suffer from anxiety or panic disorders, depression and are susceptible to drug and/or alcohol addiction. There are no medications to treat borderline personality, per se, so often the depression and anxiety symptoms that accompany BDP are treated with antidepressants or anti-anxiety medications. As noted earlier, drug and alcohol dependence is a significant risk for the BPD person. A particularly successful psychotherapy treatment for BPD is dialectical behavior therapy.
BPD in Entertainment
Christine Ann Lawson, Ph.D. (2002), author of Understanding the borderline mother: Helping her children transcend the intense, unpredictable and volatile relationship contends that actress Joan Crawford may have been diagnosed with BPD. As you will see in the clip provided, Mommie Dearest (1981) starring Faye Dunaway, Ms. Crawford seems to meet the DSM-5 criteria for BPD.
We have all heard the expression “walking on eggshells” and growing up with a parent with BPD is the epitome of this expression. As a child in this environment, you never know what to expect from one day to the next. A child in this environment never feels safe and cared for, never learns how to trust anyone (even themselves). As a matter of fact, often at least one of the children becomes “parentified” where he/she takes on the role of being a parent to the parent, which, as the oldest of three, I became. I was “mother” to my mom and sisters. I did not go out to play with peers or do any of the typical things kids do. I witnessed domestic violence as a result of the instability of emotions and frequent alcohol abuse. I have a specific memory of calling for and riding in an ambulance when my mother overdosed (one of her multiple attempts) and being in the room when they pumped her stomach (pretty traumatic for a 12 year old!). In addition, children in this environment are at risk for physical, emotional, mental and sexual abuse. My youngest sister and I were mostly subjected to emotional and mental abuse. Our middle sister, however, tended to get the brunt of physical abuse. I am sharing just a little of what life was like growing up in a home with a BPD parent in hopes that I can help someone understand this mental health condition and the experiences they may have had.
American Psychiatric Association. (2013). Diagnostic and Statistical Manual for Mental Disorders (5th ed.). Arlington, VA.
Borderline Personality Disorder Resource Center http://www.bpdresourcecenter.org/
National Institute for Mental Health http://www.nimh.nih.gov/health/topics/borderline-personality-disorder/index.shtml
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Shelia Wadsworth (author) from Central Pennsylvania on June 26, 2015:
Frequently,symptoms or diagnostic criteria can overlap or a person could possibly meet the criteria and be diagnosed with more than one disorder. Personally, I think narcissistic & borderline go hand in hand many times.
Catherine Dean from Milledgeville, Georgia on March 30, 2015:
I too am an adult child of a BP mother who I am now caring for in her elderly age. I was extremely abused physically and mentally. My dad and both siblings are deceased so I am the only one left to care for her and it is very difficult. Thanks for sharing your experience.
Robert Levine from Brookline, Massachusetts on March 05, 2015:
Interesting, the Hub "The Child Victim of a Narcissistic Personality Disordered Parent" sees Joan Crawford in "Mommie Dearest" as likely having narcissistic personality disorder.
Jessica on February 19, 2015:
. It is so freeing to write about your epneriexces, and that is a good thing. It's wonderful to have dreams, also. But the thing it seems being left out, here, is the most important of all. Your Creator He knows you best, He loves you most, He never leaves or forsakes you, when you call on Him to help you through this crazy thing called life. I will be praying and agreeing with Melissa and anyone else who may be praying, that God will set you free to be all that He created you to be, from the very foundation of the world, and He does have plans for you. Jeremiah 29:11,12 says: For I know the plans I have for you, says the LORD. They are plans for good and not for disaster, to give you a future and a hope. In those days when you pray, I will listen. Life's circumstances, the scriptures, the work of the Holy Spirit, all lead us to the discovery of our blindness, sin and separation. This gives us awareness of our helplessness, desperation and dependency on God, which, in turn, leads us to confession of sin and crying out to God. The clarity we have about our need relates directly to the quality of our repentance. Then we can pray with the psalmist who wrote: Out of the depths I cry to you, O Lord (Psalm 130:1). I sought the Lord, and he answered me; he delivered me from all my fears (Psalm 34).So, we cry out to God out of our weakness, and God hears our cry and delivers us. Is deliverance possible apart from weakness? Is salvation possible apart from the cross? Is not God's foolishness greater than the wisdom of man? Should we not then learn to delight in our weakness? I pray you will find your hope in Him. He is the answer to all of our cries for truth and honesty!
Shelia Wadsworth (author) from Central Pennsylvania on March 25, 2013:
Thank you, DDE, I really appreciate the feedback. Sorry I haven't responded sooner; I haven't been logging in as frequently lately so I didn't see comments. It is one of the most difficult disorders to treat. Actually, it mostly affects women (at least more women are diagnosed with it than men). I found out a few years ago that my mom had been diagnosed with it which sparked my interest in researching it to try to understand her behaviors.
Devika Primić from Dubrovnik, Croatia on February 14, 2013:
Interesting about this personality disorder, new information to me, you have a well researched hub on the topic and mostly men are affected by this disorder, I had no idea of such a disorder.