Borderline Personality Disorder Awareness Month
May is the borderline personality disorder awareness month. The public awareness campaign „Borderline#kuZrozumieniuiAkceptacji” [BorderlinePersonalityDisorder#TowardsUnderstandingandAcceptance] has just been launched to build public awareness of borderline personality disorder and its key features in order to reduce stigma and sensitise the public to the problems and needs of people suffering from the disorder. The campaign activities are addressed also to people with a BPD, their families and their immediate environment.
Additionally, the goal of the campaign is to reach professionals from the psychiatric and psychotherapy community and decision-makers to draw their attention to the difficulties in accessing appropriate treatment for the disorder.
Excessive emotionality, theatricality and behavioural instability
Due to the developmental nature of borderline personality disorder, the therapeutic care of patients from this group is long-term and requires the coordination of multifaceted interventions, which in turn generates significant time, financial and social costs. The specificity of BPD symptoms is also associated with increased mortality compared to the general population, most often as a consequence of suicide attempts and acts of self-harm.
The DSM-5 classification (the most recent classification of mental disorders by the American Psychiatric Association) includes BPD in the so-called cluster B of personality disorders (along with narcissistic, histrionic and antisocial personality disorders), whose common manifestation is excessive emotionality, theatricality and behavioural instability.
It should also be noted that each of us has a unique set of personality traits. Contemporary psychotherapeutic concepts describe personality precisely as a spectrum of traits which, depending on their constellation and intensity, reflect a personality type/style or its disorder.
Personality disorders are understood as ingrained and established behavioural patterns manifested in inflexible responses to a variety of social or individual situations. These behaviours are extremely or significantly different from the culturally average ways of perceiving, thinking and feeling. They tend to be perpetuated and to involve multiple spheres of human functioning (involving the social, emotional, motivational-emotional, cognitive spheres). They are often associated with subjectively perceived suffering (depressive or anxiety symptoms) and difficulties in social functioning.
Borderline personality disorder – a disorder from the borderland
The term borderline disorder was introduced into the psychiatric literature and psychoanalysis in the late 1930s by William Stern. It was used to describe symptoms that could not be clearly classified into the division of neurotic and psychotic disorders in force in psychiatry at the time. In fact, these people presented symptoms from both categories that are mentioned above: high emotional and sensory sensitivity, emotional vacillation, periods of depressed mood combined with anxiety, difficulty in suppressing emotions, feeling of emptiness, feeling of hurt, suspicion of others, feeling that other people's behaviour particularly affects us, tendencies to self-harm, risky behaviour and impulsive suicide attempts (symptoms closer to psychotic disorders).
Several terms are used in psychiatric nomenclature to describe this type of functioning – emotionally unstable personality or borderline personality. The latter one when translated literally means "from the borderland".
As a psychotherapist, Agnieszka Popiel [2011] notes in her work, the characteristics described above are characteristic of the times in which we live. Unlike schizophrenia or depression, neither biblical nor Shakespearean characters show functioning typical of borderline personality, and the first descriptions of this type of behaviour date back to the 19th century.
Personality disorders, unlike most mental disorders, develop from the first years of life, along with personality formation. According to John Bowlby's Attachment Theory, it is the first year of life that is crucial for building an emotional bond between the child and the caregiver, who is most often the mother.
Intimate attachments to other human beings are the hub around which a person’s life revolves, not only when he is an infant or a toddler or a schoolchild but through his adolescence and his years of maturity and on into old age
[Bowlby, 1980]
A disturbed self-image, self-harming actions, feeling of emptiness
Borderline personality disorder is distinguished by traits that are characteristic of those diagnosed:
- a distorted self-image, distorted own goals and preferences, including sexual ones – they are not able to clearly formulate plans for the near future, are afraid of making responsible decisions, do not know what they want, often change their mind, blame others for failures they experience; they cannot clearly define their sexual orientation – it is the presence of another person that counts, not their sex or age
- entering into intense and unstable relationships with others which lead to emotional crises – they fall in love in a matter of moments, after a short meeting or conversation; they talk about the very strong emotions they experience; they are accompanied by a constant desire to engage in a passionate, romantic relationship; at the same time, the fear of abandonment and various ways of "testing" whether this can happen very quickly
- strenuous attempts to avoid the experience of abandonment – blackmailing with the desire to harm oneself, suicide attempts – all that so as not to be left alone
- repetitive threats or self-harming actions – these can range from tearing minor unhealed wounds, cutting the skin to reduce anxiety, to drastic suicide attempts such as jumping out of windows or cutting veins
- a constant feeling of inner emptiness – a feeling of emptiness accompanies patients all the time; intense infatuation or various psychoactive drugs are supposed to help alleviate this condition
The reality of people with borderline personality disorder – the uncertainty of "me"
The impairment in personality functioning is mainly observed in the area of self-functioning: people with BPD do not have a coherent, integrated concept of self, and as a result, their self-esteem, sense of identity, value system or goals they set are also unstable. The resulting lack of grounding prevents one from effectively confronting the experienced negative emotions, does not allow one to develop an adequate sense of responsibility or self-criticism, and at the same time results in vulnerability to transient psychotic and depressive states.
Interpersonal functioning is also affected by the deficits. People with BPD show a lower ability to recognise the feelings and needs of others with significantly higher sensitivity and vulnerability to hurt. They perceive their loved ones through the prism of their own interpersonal needs, often diametrically changing their opinion about them – one moment making an extreme idealisation of them, the next accusing them of betrayal and neglect.
People with BPD also very often experience intensity and lability of emotions out of proportion to events or circumstances, including feelings of anxiety and overpowering separation anxiety. High insecurity in a situation of loneliness results in dependency and intolerance of the condition, which in turn increases depression centred around feelings of shame, being unhappy, miserable and worthless. In turn, limitations in emotional control lead to significant impulsivity and a tendency to take risks focused mainly on immediate satisfaction of needs. In doing so, the described emotionality is stigmatised by persistent feelings of anger and irritation, even in response to stimuli of seemingly little significance.
Borderline personality disorder is also characterised by impulsivity, which manifests itself in the form of self-destructive risk-taking behaviour or involves persistent suicide attempts and self-injurious actions. As a consequence of suicidal behaviour or more serious acts of self-harm, approximately 10 per cent of patients diagnosed with BPD die. Self-destructive actions are usually triggered by an anticipation of rejection or loss, but also by an expectation on the part of loved ones to take more responsibility for the consequences of their own actions.
Awareness in the community – "Borderline #kuZrozumieniuiAkceptacji"
It is therefore important to raise awareness of BPD in the community. It is a disorder that, due to the rapid progress of civilisation and socio-cultural changes, we will be dealing with more and more frequently. Given the developmental nature of the disorder, preventive interventions in the form of parental education on the importance of emotional bonding in the early stages of life for the proper development of the child are important.
I am a member of the scientific committee of the "Borderline #kuZrozumieniuiAkceptacji" campaign. I have been working therapeutically with patients with borderline personality traits for many years, using the tenets of J. Young's early maladaptive schema theory. In my scientific work I am also interested in this issue, trying to find out the psychological and biological background of borderline personality traits.
(Photo:Maciej Andrzejewski, Communications and PR Centre, University of Lodz)
Text: Prof. Monika Talarowska, Institute of Psychology, Faculty of Educational Sciences, University of Lodz
Source: Fundacja zPogranicza Anki Mrówczyńskiej
Edit: Iwona Ptaszek-Zielińska, Communications and PR Centre, University of Lodz
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