A Basic Guide to Borderline Personality Disorder
Thrive • June 1, 2021
UNDERSTANDING BPD
Borderline personality disorder (BPD) is typically explained using the Biosocial Model because the condition is influenced by a person’s biology and environment. Individuals struggling with BPD have a biological predisposition that causes them to experience their emotions much more intensely and for a longer period of time than the average person. Their environment can further exacerbate this biological predisposition by being unable to provide the support necessary for them to learn how to manage their emotions.
To people on the outside, it may seem like these intense, prolonged emotional experiences are overly dramatic outbursts. In reality, the individual suffering from BPD is experiencing their emotions at an extremely intense level. If the environment (i.e. family) doesn’t understand what is happening on a deeper level, they may provide invalidating responses like, “I need you to calm down,” or, “Just be patient.”
These interactions can lead to the development of an unfortunate dynamic where the individual understands that their responses are ineffective, but they don’t know how to manage their emotions. Unfortunately, because the environment is struggling to understand the experience of the individual, they tend to oversimplify the solution without actually teaching the individual how to tolerate their emotions.
THE SYMPTOMS OF BPD
Individuals with BPD may:
- Become intensely upset by seemingly small causes and stay upset for a long time.
- Struggle to maintain relationships. They feel caught between loving and hating a person, but not wanting them to leave.
- Feel great one minute, then feel the worst they’ve ever felt in their life the next minute while struggling to remember that emotions are transient.
- Engage in extreme behaviors to try to get relief from their emotional pain. Sometimes they may even resort to self-harm as a way to alleviate their pain.
- A preoccupation with suicide can also be a symptom of BPD. For example, they may start the day feeling great, then resort to considering suicide because they broke their favorite coffee mug. Oftentimes, suicide becomes the answer to any and all problems that are encountered throughout the day, especially if they are harboring the belief that they are ineffective at managing their own lives.
- Engage in a rigid way of thinking called ‘black-and-white thinking’ or ‘all-or-nothing thinking.’ They become trapped between opposites like, “This always happens to me, every single time,” or, “I can’t do anything right.”
- Suffer from pervasive self-invalidation of their emotions. In other words, they hide their inner turmoil, fearing judgment or being misunderstood due to their emotions.
- BPD can co-occur with other mental health concerns including but not limited to: eating disorders, depression and bipolar disorder.
DIAGNOSING BPD
If you or someone you know is in constant emotional pain and is engaging in problematic behaviors in an attempt to manage or distract from the pain, a mental healthcare provider can offer a screening to determine if a full assessment is necessary.
Because BPD has similar symptoms to other disorders, such as bipolar disorder, it’s important to have a thorough assessment done by a mental health provider. Additionally, BPD can occur in addition to bipolar disorder. For this reason, assessment and diagnosis of BPD can take some time.
Here are some of the differences between BPD and bipolar disorder:
- BPD is an issue of how one’s brain is physically wired or formed, while bipolar disorder results from a chemical imbalance in neurotransmitters.
- Bipolar disorder can be treated with medication that addresses the chemical imbalance; whereas, individuals with BPD must change their behavioral responses which eventually results in a physical change in the brain. Because BPD is the result of how the brain is structured vs a chemical imbalance, medication is ineffective long-term.
- The emotional intensity experienced by people with bipolar and BPD differs in the length of time and co-occurring symptoms. Bipolar results in periods of elation that can last days with a diminished need for sleep, usually followed by an emotional “crash” where the person experiences depression for a week or more. Emotional intensity in BPD is usually shorter in duration and fluctuates more frequently. Bipolar is often fairly cyclical and predictable in that periods of elation, or mania, are followed by periods of depression. BPD can include any combination of all or some of the emotions within a relatively short period of time and is usually related to an environmental trigger.
- And… BPD and bipolar can also be co-occurring in which case both conditions need to be addressed.
TREATING BPD
When someone is diagnosed with BPD, usually the next question is, “Okay, so what do I do with that?”
The answer is that BPD is manageable. Attending a Dialectical Behavioral Therapy (DBT) program, which is designed to treat the cluster of behaviors and co-occurring issues that are associated with BPD is the most ideal form of treatment. A DBT program includes attending weekly group therapy sessions to learn DBT skills, as well as working with a therapist individually to finetune and apply the skills.
At its heart, DBT treats emotional dysregulation and the problems that tend to come with it. DBT was developed in the late 1980s by Marsha Linehan. Linehan later disclosed that she, herself, suffered from BPD. At the time, no one really knew what BPD was, let alone how to treat it. After years of hospitalizations and lack of effective treatment options, she began to consider how to pursue life differently which led her to explore how effective people live their lives.
Linehan found that there are four parts of life that are necessary to master, which are taught in a DBT program.
The four modules of DBT are:
- Mindfulness: Linehan borrowed from different spiritual and religious practices to teach individuals how to quiet their minds, so they can reside fully in the present moment.
- Interpersonal effectiveness: The goal of DBT is to figure out what your life worth living looks like and how to get there. In everyone’s life that is worth living, there are other people involved. This section teaches individuals how to form supportive, loving relationships and how to troubleshoot those relationships when necessary. It also helps individuals realize what relationships are damaging and how to end them.
- Emotion regulation: All effective people can regulate their emotions. Regular practices can help keep emotions in a more manageable range, including sleeping enough, incorporating movement, avoiding mood-altering substances, and caring for your physical health. Incorporating pleasant events in your life and actively doing things that challenge you are also important practices that reduce vulnerability to negative emotions. This section also includes information that helps individuals understand what their emotions are, where they come from, and what they are telling them about their environment.
- Distress tolerance: After blowing a tire on the freeway, how do you survive the situation without making it worse? This section teaches individuals how to respond to distressing, unplanned events in a way that doesn’t add to the crisis. The distress tolerance section also teaches the skill of radical acceptance which allows us to move on from hard realities, so we don’t get stuck ruminating about whether it should have happened or whether it was fair.
HEALING FOR FAMILIES
One of the unfortunate hallmarks of BPD that often contributes to the development of the disorder is an invalidating environment. An invalidating environment can be dismissive, neglectful, and abusive. An invalidating environment can also be a warm and loving family that doesn’t understand how to support their loved one.
Families with a loved one who is struggling with BPD would likely benefit from professional help. Professional support and DBT skills training can help teach family members how to understand what their loved one is experiencing and ways to reduce unintended invalidation.
For example, a child may suffer from extreme tantrums that have no obvious cause. As a result, parents can feel confused and frustrated with the intensity of the emotional reaction and feel helpless in attempting to stop it. Professional support can help parents to understand what is happening and offer ways to help their child to manage these intense emotions while also managing their own anxiety and frustration. With early intervention, parents can also reduce unintentional invalidation and likely reduce many of the symptoms of BPD over time.
BPD is an interwoven condition. The problems tend to exacerbate themselves, but the solutions also tend to expand on themselves.
LIVING A FULL LIFE WITH BPD
While it is understandable that you would want to “cure” or get rid of BPD initially, this goal is unrealistic and often leads to approaches that prove unhelpful. Adjusting or adopting the mindset of management can be more effective and eventually lead to a positive outcome. BPD does not have to be an overwhelming burden. With treatment and support, BPD can bring a sense of richness to life that would not be possible without it.
Experiencing emotion on such an intense level can be like a superpower. Superpowers can be painful if you don’t know how to manage them or control them. When you experience emotion on a deeper, more intense level than the average person, you also tend to be more attuned to the emotions of others. With time and practice, it is highly likely that you will be able to accurately identify what those around you are feeling, sometimes better than them! And with all the skills and strategies you learn from treatment, you can help others to manage their emotions, too. This emotional intelligence can be an asset in several fields including mental health, social work, management, public outreach, etc. Once you have the skills to manage and regulate your emotions, you can take back control of your choices and be free to pursue your life worth living!
About the Author
SHANNON SERVI, MSW, LCSW — Clinical Lead and Therapist at Thrive
Shannon Servi completed her master’s in social work at the University of Nevada, Reno. Shannon has worked in the mental health field for over a decade, helping people heal from eating disorders. In addition, she has experience working with individuals struggling with anxiety, depression, trauma, intense emotional dysregulation, grief, and substance use. Shannon has training in Dialectical Behavior Therapy, Cognitive Behavioral Therapy, Exposure Response Prevention, and Motivational Interviewing.
It is one of Shannon’s beliefs that our pasts do not have to dictate our future and we are often stronger, more resilient than we realize. Recovery is possible. Healing is possible.
Shannon is a homegrown Nevadan and enjoys sunshine, stand-up comedy, poetry, and quasi-competitive board games. And dogs. She loves dogs.
The post A Basic Guide to Borderline Personality Disorder first appeared on Thrive Wellness.
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Teen eating disorders are serious. As a parent or caregiver, one of the most difficult situations you can face is noticing that your teen may be struggling with a basic human need like eating. Adolescence is already a rough period for many teens filled with fluctuating emotions, changing bodies, and social pressures. However, sometimes coping with these challenges can manifest in unhealthy ways, like developing complicated relationships with food, body image, control, or exercise. Many teens face body image issues as their bodies mature, excessive pressure to meet unrealistic expectations fueled by social media and peers, and emotional instability and anxiety during their adolescent years, all of which can combine to create the perfect storm for an eating disorder. These challenges can often make your teen more vulnerable to unhealthy coping mechanisms , such as restricting food intake, excessive exercise, or engaging in disordered eating behaviors . 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Why It's Crucial to Seek Medical Help When you notice warning signs, it’s important not to wait to get help. Eating disorders can be life-threatening, both physically and emotionally. They take a serious toll on a teen’s health, affecting their metabolism, hormonal function, and overall well-being. Beyond the physical impact, eating disorders can often involve deeply ingrained psychological and emotional challenges, such as low self-esteem, anxiety, depression, and trauma. After an initial conversation, the first step is to schedule an appointment with a medical provider. Your teen’s primary care doctor or a pediatrician can help evaluate their physical health and provide guidance for next steps. Be prepared to discuss the specific behaviors or signs you’ve observed, as this will help your provider better understand the situation. The doctor may conduct a physical examination, lab tests, and discuss your teen's emotional and psychological state. 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Seek medical advice first, and build a support team of professionals who can work together to provide comprehensive care. Eating disorders are complex, and it’s not something you or your teen should have to face alone. Taking swift action and offering compassionate support will help your teen regain control of their health and their life so that they can thrive through their adolescence and beyond. At Thrive, we offer specialized treatment for anorexia, bulimia, binge-eating disorder, and avoidant/restrictive food intake disorder (ARFID). Our adolescent intensive outpatient and partial hospitalization programs have not only changed lives, but saved them. If you believe your teen is struggling, don't hesitate to reach out for help, we are ready to conduct a complimentary intake assessment today. To learn more about eating disorders, download our free guide "Recovery is Real" filled with practical insights and strategies to help a loved one navigate the journey toward recovery.
It can be difficult to know when it's time to reach out for help. We often try to manage stress, anxiety, sadness, or relationship issues on our own, thinking it’s just a phase or something we can work through to “get over.” But sometimes, these feelings or behaviors persist and can start affecting our overall mental and emotional well-being. The truth is, seeking therapy shouldn't be a last resort. Therapy is a valuable tool for anyone looking to better understand themselves, improve their emotional health, and work through life’s challenges. If you’ve been wondering whether it’s time to seek therapy, there are a few key factors to consider when performing a self-evaluation. Here are five signs that it might be time to reach out for additional support: 1. Is My Mood Affecting My Life or Relationships? One of the most telling signs that you may need support is noticing that your mood is negatively impacting your daily life or interpersonal relationships. Have you noticed an increase in conflict with friends, family, or colleagues? Are you feeling stuck in patterns of negativity that seem hard to shake? If your mood is affecting how you function at work, school, or in your personal life, it may be time to talk to a therapist. Pay attention to your behaviors; are you withdrawing from activities you usually enjoy? Are you reacting more intensely to situations than usual? If your emotional state is beginning to impact your relationships, interactions, or your ability to move through everyday life, a therapist can help you explore underlying causes and develop tools to improve your social wellness. 2. Am I Isolating Myself to Avoid Conflict? There’s a big difference between being introverted and isolating yourself as a way to avoid conflict. If you find yourself consistently pulling away from social situations, not because you need time to recharge, but because you’re avoiding uncomfortable conversations or emotional confrontations, this could be a sign of a deeper issue. It’s natural to want to avoid tension or discomfort, but consistent isolation can worsen feelings of loneliness and make it even harder to work through conflicts. Therapy can help you learn healthy coping mechanisms, problem-solving and communication skills, so you can feel more comfortable facing conflict in a productive way rather than shutting down or avoiding it at the cost of self-isolation. 3. Are My Emotions Out of Control? Do you ever feel like your emotions are so overwhelming that you can't regain control? If you're finding it difficult to calm yourself down, quiet your thoughts, or manage your feelings, this might be a sign that therapy could be helpful. Emotions like anger, disgust, fear, anxiety, or sadness are natural, but if they start taking over your thoughts and actions, it can be exhausting and difficult to complete daily tasks. A therapist can help you understand why your emotions are so intense and teach you strategies to regulate them and regain a sense of balance. 4. Have I Experienced Trauma That’s Affecting My Daily Life? Trauma comes in many forms, it could be from a single incident or from ongoing experiences that have affected your sense of safety, connection, or well-being. Sometimes, trauma is tied to experiences in childhood, but it can also be linked to recent events, like accidents, loss, or abuse. If you've experienced trauma and are struggling to perform basic daily tasks or meet your needs, therapy can be incredibly beneficial. Unresolved trauma can lead to feelings of anxiety, depression, or being stuck in past experiences. A trauma-informed therapist can help you process these experiences, understand their impact on your life, and work toward healing and recovery. 5. Am I Hurting Myself or Others? If your mood or behaviors are causing you to hurt yourself or others, it’s crucial to seek help immediately. Whether it’s through emotional or physical self-harm , or unintentionally inflicting harm on the people around you, this is a serious sign to find support from mental health professionals. A therapist can provide a safe, nonjudgmental space to talk about what you’re going through and help you work toward healthier ways of coping. If you’re in immediate danger or experiencing thoughts of self harm, it’s essential to reach out for help as soon as possible. There’s no shame in seeking support when you're struggling with harmful thoughts or actions. Why is Professional Mental Health Support Necessary? Although there may be barriers to seeking therapy, reaching out for professional mental health support is worth it to address the emotional and psychological issues that you shouldn’t have to deal with alone. Therapists have the knowledge and tools needed to guide you through your struggles, offering insights and solutions that aren’t available outside of the therapeutic setting. Their expertise promises not only a deeper understanding of your challenges, but the application of practical methods and skills to resolve them in your everyday life. Additionally, trained mental health professionals offer personalized strategies and coping mechanisms tailored to your unique situation and needs. These strategies are informed by evidence-based practices and a therapist’s experience working with and healing emotional and mental struggles. Personalized therapy helps clients receive the most relevant and effective guidance for their personal challenges. Embracing the Journey Toward Mental Wellness Recognizing that you might need support is the first step toward feeling better and getting the most out of life. Therapy isn’t just for when things are at their worst; it’s a proactive way to improve your emotional health, work through challenges, and build skills for resilience. If you relate to any of these situations, it might be time to reach out and explore therapy as an option. It’s okay to need help, and you don’t have to navigate this journey alone. If you’re unsure whether therapy is right for you, consider talking to a mental health professional to discuss your concerns and explore specialized support options available to you. You deserve to feel your best, and therapy can be a stepping stone to help you reach your goals. Are you in need of support? At Thrive Wellness, we offer personalized therapy and treatment to support you in whatever you're going through, don't be afraid to reach out for help . We also offer a FREE comprehensive guide to wellness in our “How to Thrive” guide . This guide offers practical, easy-to-follow habits that promote physical, mental, and emotional well-being. Start your journey towards a balanced and fulfilling life today with these simple yet transformative steps.
