Breaking Down Borderline Personality Disorder Symptoms -
Borderline personality disorder is a complex mental illness that is heavily stigmatized and because of this, there is a LOT of misinformation on the internet. Fake news is bad enough, but getting false information about your own, or a loved one’s diagnosis can be life-ruining. So many people with BPD, or their loved one with BPD, believe they cannot change; this is bullshit.
Without a basic understanding of what BPD actually is, and the basics of how it works, it is impossible to recover. Education creates understanding, boundaries, and gives people a map out of the horror that can be the BPD mind.
People with BPD experience emotions in a very severe way- and BPD is linked strongly to adolescent trauma. Overwhelming emotions can lead people with BPD to have a distorted perception of reality (Everyone is always staring at me) or swing into short-term breaks from reality in times of stress (My long-term loving partner hates me and wants to hurt me because I didn’t do the dishes).
These breaks from reality are strongly emotional and involve all or nothing thinking- “my crush is deeply in love with me and will fix all the parts of me that feel broken, they are the perfect person and can do nothing wrong” or “I lost my phone-everyone I know is going to hate me because I can’t contact them, they’re all going to leave me, my boss is going to fire me” these thoughts and emotions are the constant, daily reality for people with BPD.
BPD is hard to understand, it is complex, and symptoms can be extreme. To better understand your loved one with BPD, or yourself, it is important to have a solid grasp on all nine of the BPD symptoms. Most people with BPD do not have all nine symptoms- but they must have at least 5 to be diagnosed.
Disclaimer: BPD has a heavy stigma attached to it inside and outside the mental health community, which I do not support or believe in. People can only begin to heal when they have a supportive social environment, it is imperative we are compassionate to everyone suffering from mental illness.
It is very important to me that everyone understand the examples I will give below emphasize symptoms to create a better understanding between people with BPD and people without BPD. These symptoms are only common among people who are not in treatment for their BPD.
People with BPD who work hard in treatment will have many ways of expressing or controlling these symptoms and often can avoid reactions that may hurt their loved ones. The majority of people with BPD have reduced symptomology as they age and are able to lead healthy lives with treatment.
“Affective Instability Due to a Marked Reactivity of Mood” aka Volatile Mood Swings
The most noticeable symptom of BPD (and why it is often misdiagnosed as bipolar disorder) is extreme mood swings and emotional dysregulation. They can go from dancing around the kitchen to sobbing in the corner in an alarmingly short amount of time for neurotypicals (mentally healthy people) to comprehend.
When a person suffers from emotional dysregulation, they have emotional responses that do not lie within the normal or culturally acceptable level of response. For example, a person with BPD may want to scream and jump up and down when their partner gives them a loving compliment, while a neurotypical person would just smile and say thank you.
People with BPD are easily emotionally triggered and are commonly called “emotional/sensitive/dramatic” by loved ones. A person with BPD may yell at their spouse for not noticing their haircut, or self-harm after a significant other forgot to kiss them goodbye. A person with healthy emotional regulation can see the reality of situations-unnoticed haircut is not a sign of abandonment, a forgotten kiss is not hatred.
A person with BPD has a huge wave of emotion (hormones) to the normal circumstances-their amygdala (the part of your brain responsible for flight/fight/freeze hormones) floods their bodies with hormones/emotion. People with BPD are not acting out symptoms from a place of maliciousness or manipulation, their systems experience huge waves of emotion that mess with their ability to reason.
Along with huge waves of emotions, people with BPD have a very hard time calming themselves down; their prefrontal cortex (a part of your brain responsible for self-control) doesn’t respond as fast as a healthy person’s, allowing the huge emotional swings they feel to become behavioral outbursts. A small amount of hurt can easily become over-consuming panic with a slow prefrontal cortex reaction.
Normal interaction -> triggers Insecurities/Trauma -> amygdala overreacts -> emotional dysregulation/inability to calm down -> inappropriate behavior
A person with BPD sees a spouse not noticing a haircut as a sign of disinterest and therefore perceives abandonment (another symptom we’ll cover later). The sense of betrayal and abandonment flood their entire body, and their brains cannot regulate (calm down) the emotion they feel, so they react inappropriately. Emotional dysregulation is an illness, not maliciousness.
That is not to say that the inappropriate behaviors of people with BPD cannot be forms of manipulation. In the middle of such extreme emotions, people with BPD cannot empathize with others since their survival instincts/emotions take over. Just as a neurotypical person cannot emphasize with the person they’re in a fistfight with. The emotions are all-consuming and calming down is nearly impossible without training.
Try to imagine the most heartbreaking moment of your life. Seriously, take a moment and pull up one of your most painful memories. Now imagine if you felt that way every time something minor happened- BPD emotions for hearing their child broke a bone is how you might feel finding out your child needs brain surgery. How you would feel seeing your spouse kiss someone might be how they feel when their spouse laughs at another persons’ joke- everyone can logically understand that those situations are very different, but people with BPD will have overwhelming emotional reactions.
It is easier to understand people with BPD’s inappropriate behavior when you can remember the intensity of their emotions is consistently extreme in day-to-day occurrences. Reason cannot stop or often help these emotions. People with BPD must be given behavioral skills learned in therapy to begin understanding and controlling their emotions.
Frantic Efforts to Avoid Real or Imagined Abandonment
The most common break from reality that borderline patients experience is imagined abandonment. People with BPD can be extremely sensitive to any sense of abandonment (imagined or real) and often have unhealthy attachment styles stemming from adolescent trauma.
Adolescent trauma -> attachment disorder ->Emotionally protective actions/ act out against loved one -> fear of abandonment + emotional dysregulation -> frantic effort to avoid abandonment
A change of tone in a crush’s texts may have them (wrongly) perceive their crush now hates them, and because of this imagined abandonment they may text and leave voicemails in an increasingly frantic manner to stop the perceived abandonment:
“lmao ur not gonna text me back?” “your such an asshole” “Fine just leave then I don’t care” “Im sorry I didn’t mean that” “Please respond” “Im going to hurt myself if you don’t respond” “I can’t believe you would do this to me”.
It is important to note that a lot of people without BPD see these inappropriate behaviors as a form of malice/manipulation, instead of a symptom of a disorder. To have a healthy relationship with someone with BPD, you have to rethink how you view BPD behavior. The inappropriate behavior people with BPD have when they lash out is not about the person on the receiving end. The behavior is about previous, usually adolescent, trauma that has been triggered by a normal interaction and an overreactive amygdala.
The person with BPD has to relearn how to handle their fear of abandonment, and no one should stay in a relationship that makes them feel uncomfortable. You are never obligated to keep someone in your life. I’m simply trying to give others a different way to perceive their loved ones with BPD.
Outright manipulation such as “I'm going to hurt myself if you don’t respond” is only common among people with BPD who have not received treatment, and self-harm is another symptom of BPD we will discuss later. Since BPD treatment (Dialect Behavioral Therapy) strongly focuses on self-control, patients who follow the program are much less likely to react this way.
If you or a loved one want to self-harm, please seek professional help. A coping mechanism box, filled with distractions and alternatives to self-harm, is commonly used by people who struggle with such urges.
The escalation of effort to keep the people they love in their lives is common, but so is the opposite. A lot of people with abandonment issues will push loved ones away to test them, then flip and frantically make sure they won’t leave.
A person with BPD may ignore their girlfriend's text for a few days to feel in control of the abandonment they feel is inevitable, then when the girlfriend says they’ve had enough, will swing wildly to the opposite side and love-bomb their girlfriend to try and avoid the abandonment they were trying to control earlier.
This push and pull is exhausting for both people with BPD and their loved ones; it is important to note that usually actions and reactions are not conscious, but subconscious fears being acted on in harmful ways. It is possible to name, control, and break these cycles with treatment.
Fear of abandonment is not rare or specific to BPD but coupled with emotional dysregulation can easily lead to the next symptom: unstable relationships.
A Pattern of Unstable and Intense Interpersonal Relationships Characterized by Alternating between Extremes of Idealization and Devaluation
Interconnected strongly with fear of abandonment and emotional dysregulation, people with BPD often have a hard time maintaining long-term healthy relationships. Some people with BPD will only have unstable relationships in one area- such as friendships, family, or romance. Others will have unstable relationships in every area.
The instability will normally relate to the type of childhood trauma a person with BPD experienced- a person with trauma from early abusive romantic relationships but with a loving family is going to have a much different type of instability than someone who had an abusive family and found solace at their friend’s houses.
Humans have evolved as social animals who need interaction. Stable relationships or community support are a crucial part of every person’s mental health and are categorized under the psychological need of “relatedness”. Most people with BPD do not get diagnosed until they are in a hospital after an attempted suicide, and most do not seriously dedicate themselves to treatment until a stable person (or someone they want to be stable with) pushes them to.
The basis of BPD makes relationships difficult. A healthy person needs to have an in-depth understanding of how the BPD works, and strong boundaries of their own to create a working relationship. A person with BPD must also take on the personal responsibility of treatment to make themselves a healthier person who can accept and work towards a healthy relationship.
A lot of people with BPD who have been in treatment can eventually hold long-term jobs and friendships, but familial (most common source of trauma for BPD) and romantic relationships are a challenge. Romantic and (unstable) family relations often involve the more intense emotions in a person’s life-so more instability makes sense within the context of BPD.
The unfortunate reality is that people need a supportive social environment to heal and grow. Relatedness as a psychological need has to be a part of healthy life. Since people with BPD often cannot keep these stable supportive social environments, they often don’t attempt treatment.
Identity Disturbance: Markedly and Persistently Unstable Self-Image or Sense of Self
People with BPD have a hard time understanding/knowing themselves. They may seem like teenagers in their ability to switch interests, social groups, hobbies, and appearance. When you don’t know who you are, it is very easy to become codependent on the people around you to define you. People with BPD may switch all their hobbies to match their partners, or only do things their parents want.
Identity disturbance is very intertwined with self-esteem issues, as you might remember from being in high school. Without a foundation of self, you can’t build confidence. People recommend building confidence by engaging in favorite hobbies, taking care of your appearance, etc. But what hobbies do you do if you can’t find anything you love? How do you create your appearance to your liking if you have no idea what you like? When you have few stable emotions, relationships, hobbies, how could you build an identity?
This is not to say that people with Borderline cannot form identities, or that they don’t have an identity. Identity disturbance just means that their identity is not as fully formed or shaped as a neurotypical person is. They may know they love painting but will stop painting anytime they have a best friend because they only want to do what their new best friends want to do.
With encouragement, supportive environments, and treatment, people with borderline can quickly begin to form full identities based on their personal wants/needs/feelings/beliefs/hobbies, etc. Identity is a very important part of the recovery process, as it gives the person with BPD a solid foundation on which to start building self-esteem, relationships, and self-love.
Chronic Feelings of Emptiness
Connected to lack of identity and dissociative symptoms (below), people with BPD often describe an emotional hole/void/pit inside of them. This feeling of emptiness can lead to bad coping mechanisms to ignore it- drugs, alcohol, sex.
Unhealthy attachment styles stemming from childhood, lack of identity, lack of stable emotions, lack of stable relationships, are all individually good reasons to feel emptiness. Combine them all together and the emptiness can become a severe mental illness symptom for many people.
For people without BPD, the connection between overwhelming emotions and chronic feelings of emptiness can seem an odd combo. Emptiness itself is an extreme emotion- try to imagine the loneliest you have ever felt, now try to imagine living life trying to run away from that feeling. That’s how many people with BPD live their everyday lives.
emotional dysregulation -> unstable relationships -> lack of identity -> chronic feelings of emptyness -> impulsivity to cope with emptyness
Impulsivity in at Least Two Areas that are Potentially Self-Damaging (e.g., spending, sex, substance abuse, reckless driving, binge eating)
You can imagine that if you have a hard time regulating your emotions, you probably have self-control issues. Huge swings of sadness/anger/shame/jealousy can cause people with BPD to engage in bad coping mechanisms just to try and escape the overwhelming pain of the emotion.
Self-control is an important skill taught in DBT therapy; when faced with the overwhelming emotion, remember the DRC rule; Distract (funny Youtube video, Netflix, a pet) Relax (Deep breathes, meditation, mindfulness skills) Cope (journal your feelings, call a friend, rant to your pet, fix the situation if possible). Without guidelines and classes on how to deal with their overwhelming emotions, people with BPD have low self-control, which directly leads to impulsivity.
Many people with BPD struggle with addiction or addictive tendencies because of this impulsivity. Addiction is technically only when the body becomes dependent on a substance to function normally, but psychological dependencies (shopping addiction, gambling addiction) are slowly becoming more accepted under the addiction label. On this blog when I talk about addictions, I am including psychological dependency too-just because it doesn’t hurt you physically does not mean it can’t be incredibly toxic. Alcohol, drugs, smoking, and self-harm are some of the most common addictions seen in people with BPD. Self-harm is important to include because of the majority of people with BPD currently or used to engage in it. Self-harm is commonly used as an emotion-numbing technique, much like alcohol.
A section of impulsivity/self-harm that many people feel uncomfortable talking about is hypersexuality. Hypersexuality is when a person engages in a large amount of unwanted sexual activity to feel in control of their sex life-it is not the same as nymphomania or being promiscuous (although both of those can be a part of it). Hypersexuality is a common coping mechanism after sexual abuse-especially if the abuse happened around puberty. A person who is sexually abused or manipulated and becomes hypersexual is searching to control what they could not control during their abuse- their sex life. Hypersexual people can feel triggered and heavily abandoned when denied sex, because their trauma brain is telling them that being denied sex is having all of their worth/love denied. Hypersexuality, like all symptoms, exists on a scale. Having a healthy sex life is important, but when self-worth is tied into sexual performance it can easily lead to impulsive judgement around sexual decisions. Consenting to sex when they actually don’t want to, pushing themselves to sleep with partners before they are ready, deciding not to use condoms because their partner says they don’t want to, using sex to try any increase self-esteem, and feeling like sex-drive is “out of control” are all common symptoms of hypersexuality.
Emotional Dysregulation -> Low self-control -> Impulsivity -> Addiction/Psychological Dependence
Recurrent Suicidal Behavior, Gestures, Threats, or Self-Mutilating Behavior
Many people with BPD do not get a correct diagnosis or treatment until after they have attempted suicide and end up in hospital care. BPD has one of the highest death rates of any mental illness; its only competition for first place is anorexia.
Tragically, 10% of people with BPD take their own lives, and 70% will attempt suicide at least once. To put it into perspective: 10% means that a person with BPD is 50x more likely to die of suicide than the general public is.
Oftentimes people with BPD are attempting suicide because of sudden extreme emotional pain at the moment and are not considering the consequences of actually dying; the goal is to escape the immediate pain.
Another seemingly extreme way of dealing with overwhelm emotions is to self-harm. BPD live in extremes, and coping mechanisms (unhealthy or healthy) that work immediately are desired; between 65–80% of people with BPD engage in self-mutilation behavior. Self-harm releases endorphins into the bloodstream to deal with the physical pain, the body naturally reacts to focus on the physical pain, thus causing the emotional pain to hide for a bit.
Self-harm and suicidal behavior should belong in different categories. The two are certainly correlated, as mental health issues cause both, but they do not have a causational relationship. Many people who self-harm are not suicidal, and many people who commit suicide did not self-harm.
Self-mutilation is an extreme emotional regulation technique-most people report using to handle the emotions they were feeling.
The link between self-mutilation and suicide attempts is a common misconception. They have no causal relationship to each other, instead, there is a hidden third variable: Emotional Regulation. People who either have mental illnesses or trauma (soldiers with PTSD, parents whose children have died) are more likely to self-mutilate and attempt suicide because they cannot handle the emotions they are feeling.
Emotional dysregulation -> self-harm
Emotional dysregulation -> suicide attempt
Inappropriate, Intense Anger or Difficulty Controlling Anger
Once again directly related to emotional regulation, anger issues are common among people with BPD. In fact, they are so common that people with BPD who can push their anger inside instead of out at other people have been given a special name- quiet borderline personality disorder.
Anger is the hardest emotion for many neurotypical (not mentally ill) people to control and deal with; it is even a reason in our criminal justice system to lessen a murder charge; murder committed during huge emotional bursts (aka not premeditated) carries a lesser sentence. It should be no surprise that it is often also people with BPD’s most difficult emotion to regulate.
People with BPD are often shamed for their extreme emotions. This shame can lead to repression of emotions, which eventually comes back out in huge outbursts.
Emotional dysregulation -> shame from others for emotions -> repression of emotions -> angry behavioral outbursts
Transient, Stress-related Paranoid Ideation or Severe Dissociative Symptoms
Dissociation is defined as a phenomenon involving detachment from reality. It is really important to understand this is not the same thing as psychosis; where you have a break from reality. Detachment from reality is felt by everyone at some point in their life. Marijuana highs create a similar detachment to dissociation, but weed also makes you happy by keeping dopamine in your synaptic gaps, dissociation does not.
Have you ever looked at yourself in the mirror and really tried to understand who you are? Or had a moment you felt like you were outside your body watching yourself? Those experiences are common of dissociation.
76% of people with BPD experience mild to severe dissociation regularly. Everyone dissociates occasionally, but severe dissociation can interfere with relationships, careers, and intrapersonal understanding. Dissociation becomes a habit for people living in a constant bodily state of emergency, which is common in people with BPD.
Intense mood swings can swing suddenly into being “zoned-out” for hours. The beginning of a panic attack could suddenly switch to the inability to do anything besides sit and stare at a wall because dissociation is a way to protect a person from distress.
The most common types of dissociation are a sense that the self is unreal (depersonalization) and a sense that the world is unreal (derealization). My favorite way of showing the difference is that derealization would be feeling like you are the only real thing and the world around you is a (boring) video game, and depersonalization would be the opposite; you feel like a ghost, but the world stays (semi) consistent.
Emotional dysregulation -> innapropriate behavior -> shame/punishment for behavior -> learn how to “block out” emotions through dissociation
Honorable Mentions: Symptoms Not Included In BPD Diagnosis but Widely Accepted by BPD therapists and the BPD community
- Black and White Thinking
People with BPD often have a hard time seeing the grey in life- things are either “AWESOME!” or “complete shit”. Black and White Thinking is a general symptom that can be applied to anything in a person with BPD’s life: relationships (called Splitting), religion, politics, house decorations, school work, therapy work, types of food, talents, hobbies, others opinions, etc. Very few things are ever neutral.
2. Splitting
People with BPD often see others, especially those they are closest to, in terms of “perfect” or “evil”. The term splitting applies to when a person with BPD has a sudden switch of opinion. A long-term partner could be “perfect” for half the day, then forget to hug the BPD partner when they get home, and the person with BPD will experience an intense split where their partner suddenly becomes “evil”. This is linked with both emotional dysregulation and unstable relationships
3. Favorite Person
“favorite person” is a term used in the BPD community to explain why people with BPD often attach themselves, their emotions, identity, and well-being to one person. A favorite person can be anyone- a romantic partner, therapist, best friend, coworker, etc. A person with BPD can become obsessive with their favorite person and will split on them (see above) consistently. Being a favorite person can be emotionally taxing, and having a favorite person can be overwhelming.
The symptoms of BPD are complex and not easy to comprehend for many people. I hope by breaking down the 9 different symptoms I have given you a better understanding of this serious mental illness. What people with BPD need more than anything else from their loved ones are strong boundaries, patience, and unconditional kindness.
For everyone who read this article that has BPD- never stop fighting. You deserve to be here and I am already so proud of you for the progress you have made, no matter how small. I have seen so many people with BPD get help and go on to live healthy, happy lives. I know you will find yours too.
Originally published at https://kosowrote.com on October 2, 2020.