Borderline Personality Disorder (BPD) Revisited -- Plus an Insider's Perspective of BPD
May is Borderline Personality Disorder Awareness Month.
Here are some of our thoughts on hope for people with this disorder and those around them.
An Inside Look at BPD from someone who has been there -- Shehrina Rooney, Recovery Mum, and author of The Big Book on Borderline Personality Disorder, coming Fall 2018
Fifteen years ago, most people knew very little about borderline personality disorder (BPD) and what they knew had been painted as a negative, scary disorder with no hope for improvement or recovery. Times have changed and we know much more today about BPD than ever before. That being said, it remains a confusing disorder for most.
Training Professionals about BPD
As a training institute, HCI trains professionals who handle disputes in the courts, workplace, families, community, and other settings about people who present the most complex challenges. Our focus, based on Bill’s Eddy’s High Conflict Personality Theory, is on understanding and managing people with high-conflict personalities. A key characteristic of high-conflict people (HCPs) is that they have a target of blame, who they focus all of their frustrations and anger on, so that their conflicts often remain stuck or get worse and become obviously high-conflict.
Some HCPs may have personality disorders, either diagnosed or undiagnosed, including BPD. Many people with BPD are not HCPs, because they do not focus on a target of blame. Our intent and goal has been and remains to help professionals understand behavior patterns and learn to adapt their approach and learn necessary skills to help people navigate successfully through their conflicts in every setting. The person who is ultimately helped is the person with those high-conflict behavior patterns, because those dealing with them have learned to adapt and utilize a positive strategy.
For example, people with BPD often have wide mood swings, from being very friendly to being very enraged, especially at those closest to them. So we teach professionals methods of staying calm as much as possible, while giving the person empathy, attention and respect. This often helps a person with BPD calm down and more effectively focus on problem-solving. Without this knowledge, many professionals typically get angry back at such clients and make things worse.
People with BPD also have difficulty with interpersonal boundaries and seek to avoid feeling abandoned by alternately clinging or going into a rage. Therefore, we teach professionals to give extra explanations of how they work with clients (phone calls, emails, in-person meetings, crisis management, etc.) at the beginning of a working relationship in order to develop better boundaries and realistic expectations. We encourage them not to get too close or be too rejecting of the person, but rather to remain stable in a moderate and clearly professional relationship.
We also emphasize engaging the person (possible BPD or HCP or both) to focus on positive participation in dispute resolution by asking questions, making agendas and making proposals for resolving their conflicts. We make it clear that professionals are not responsible for the outcome of their clients’ cases, but rather as assisting their clients in resolving their conflicts. Often those with BPD will blame their professionals for things beyond the professional’s control, so it must always be clear what the professional can and can’t do.
We’ve learned a lot in the past ten years, especially as we hear from the people we’ve trained and those who read our books and use our methods. From time to time we realize there are missing pieces of information in some cases or additional information is necessary in order to have a better understanding of these painful problems. We’re always open to new information.
While we know (from feedback) that our information has helped untangle the mystery of BPD and conflict for many people, we also know that it’s weaponized some who have only a minuscule amount of information about BPD. The result—labeling people who seem a little (or a lot) outside the norm as “Borderlines” or “BPD”. Therefore, we emphasize in our trainings, books and other materials, that no one should label someone else as having BPD or any other personality disorder or being a high-conflict person. Instead, just have your own internal “Private Working Theory,” and adapt your approach to dealing with the person, such as the tips described above. The goal is to change how you behave, rather than trying to change how the other person behaves. And the methods with teach can be used with anyone, whether or not they have a personality disorder or truly are a high-conflict person. So this removes any necessity for diagnosing anyone.
A Quiz of Your Knowledge of BPD
Take this true/false quiz to see if you may have some misinformation about BPD:
1. T / F Only a qualified mental health professional can diagnose BPD.
2. T / F Anyone with BPD will be a high-conflict person.
3. T / F BPD is an unrecoverable disorder. If you have BPD, you’ll always have BPD.
4. T / F Those with childhood trauma, especially sexual abuse, are certain to develop BPD.
5. T / F A parent with BPD behaviors cannot parent successfully.
6. T / F People with BPD know that they’re behaving badly.
1. Only a qualified mental health professional can diagnose BPD.
True. It’s never a good idea to suggest that anyone has BPD or label them as “a borderline”. It’s like telling someone they have cancer or they are “a cancer” just because they have a red patch on their forehead. Leave the labeling and diagnosis to the trained professionals.
2. Anyone with BPD will be a high-conflict person.
False. Of those who do have BPD, only a small percentage focus on a target of blame, and these are the folks who are most likely to be involved in high-conflict disputes. The others are regular people who deal with a lot of pain and who struggle to keep their heads above water but may in fact be conflict avoidant.
3. BPD is an unrecoverable disorder. If you have BPD, you’ll always have BPD.
False. Thousands or hundreds of thousands of people across the globe are accepting and acknowledging that they have BPD and are seeking treatment. Society is gradually accepting the idea that BPD does not have to be viewed as a scary disorder with no hope of recovery. Many people have worked through therapy to recover and live happy, fulfilled lives with successful relationships. Many have outgrown the diagnosis completely, after working hard on their own patterns of behavior, usually in some form of counseling. And many still continue to struggle. Just remind yourself that it’s a marathon for them – not a sprint – with a little help from people who understand and can give a little empathy.
4. Those with childhood trauma, especially sexual abuse, are certain to develop BPD.
False. While many people with BPD did experience childhood trauma (sexual abuse, physical abuse, neglect, etc.), not everyone with this disorder has a trauma history. For some it may be a genetic tendency and/or extreme behavior patterns they copied growing up. For others, an “insecure attachment” with or without abuse may be a factor. So, don’t assume or waste time wondering why some people have it while others don’t, or secretly diagnosing someone just because they have an abuse/trauma history. Instead, focus on using empathy with everyone, even those with BPD traits.
5. A parent with BPD behaviors cannot parent successfully.
It depends. Some people with BPD have been harmful or provided insecure attachments as parents, while others have been generally effective. Parenting success depends on the severity of the disorder and other factors, such as temperament at birth, nearby support systems, openness to learning parenting skills and/or some good therapy to help them calm themselves and learn new relating skills. Think of it this way: a person who loses a leg through amputation has to undergo therapy/treatment to learn new ways of walking.
6. People with BPD know that they’re behaving badly.
BPD is a disorder that usually starts in early childhood, so that it becomes part of the person’s personality and therefore not obvious to themselves. People with BPD (and any personality disorder) generally have a severe lack of social self-awareness—that’s a key characteristic of these disorders. They truly believe their problems are all caused by outside events or other people, and that their behavior was normal or necessary given what other people did or said. Even the most learned, skilled professionals sometimes secretly believe that those with BPD know they’re behaving badly and choose it. The reality is that this person is actually quite miserable, through no fault of their own. What comes out can be kind of ugly, sometimes vicious and hurtful, but they truly aren’t intentionally being hurtful and hateful. They are simply stuck for a brief period in the defensive brain with little to no access to their logical brain – in those moments/minutes. We need access to both to relate well with other humans. They are in full fear mode much of the time, which makes them feel like someone outside of them is a threat.
Yes, we know that relationships with someone with BPD, particularly someone in the high conflict category, can be extraordinarily difficult. It’s not uncommon for us and others who say that something can be done to help those with BPD to receive negative mail from those who’ve been in such relationships, stating that nothing can be done to help them and we’re nuts for trying. Research itself paints a different picture and our experience affirms that. The first (and not only) key is learning the skills to help them navigate the world successfully. Not easy. The second key is for them to seek treatment.
Be part of their solution!
Over the years we’ve come across some great people and programs for BPD, including some resources we have produced:
YouTube channel: Recovery Mum
Upcoming book: The Big Book on Borderline Personality Disorder
Shehrina has over 250 YouTube videos on anything you’d ever want to know about BPD. She receives feedback from BPD strugglers, their family members/spouses, and professionals, who remark that she has a unique, understandable and relatable way of explaining BPD’s many facets.
AMANDA SMITH, LCSW
Author: DBT Wellness Planner
Author: BPD Wellness Planner for Families (Summer 2018)
Amanda helps families find treatment options for their loved ones and leads online DBT learning courses for family members.
Personality Disorder Awareness Network (PDAN) is a not-for-profit organization dedicated to increasing public awareness of personality disorders, alleviating the impact of personality disorders on families, and intervening early in the personality development of children.
Help for families.