You may not be sure how they feel about you, for starters.
In your daily interactions, you’re constantly assessing and evaluating how people feel about you—often subconsciously. This helps you build and maintain relationships with your coworkers, family, and friends, and even reaffirm your self-identity.
If you’re talking to someone with borderline personality disorder, however, this assessment can confusing and conflicting. “If I’m interacting with them, I don’t always know where I stand. Am I the good person today? Am I the bad person today? Do you like me?” says Jennifer Hartstein, PsyD, psychologist in New York City.
“Borderline personality disorder is a personality disorder where the person is somewhere between neurosis—[where] the person is just typically worried about lots of different things—and psychosis, where the person is just out of touch with reality,” says Ben Michaelis, PhD, psychologist in New York City.
Borderline personality disorder, or BPD, got its name because experts originally considered this mental disorder to be atypical, or borderline, variations of other mental health disorders. BPD became its own diagnosis in 1980, according to the U.S. National Library of Medicine. The National Alliance on Mental Illness (NAMI) estimates that 1.6 percent of American adults are diagnosed with BPD; of those 75 percent of patients are women.
Someone with borderline personality disorder might present some of these hallmark signs, according to Dr. Hartstein:
Intense mood shifts and difficulty regulating emotions
Thoughts of self-harm or suicide
Fear of abandonment
Anyone might have these feelings from time to time, but for someone with borderline personality disorder, these symptoms may be persistent and pervasive, according to Dr. Hartstein. They interrupt the person’s ability to work, form and maintain relationships, and live happily.
Unstable relationships are a major concern for people with borderline personality disorder. “They see things in black and white, or all or nothing,” says Susan Samuels, MD, psychiatrist at New York-Presbyterian Hospital, Weill Cornell Medicine. Someone they consider a best friend one day could be their worst enemy the next day, which makes it challenging to be part of steady, healthy relationships .
And of course, this lack of meaningful connection with others has a compounding effect on mental health. People with BPD often have poor self-image and respond intensely to stressors, according to NAMI.
Impulsive behaviors may serve as a coping mechanism for the pervasive thoughts for someone with borderline personality disorder. “They can get involved in all sorts of dysfunctional behaviors, involving alcohol or drugs, or spending, or sex,” says Dr. Michaelis.
“A lot of the symptoms of borderline personality disorder overlap with symptoms of other mental health disorders,” says Dr. Samuels. When diagnosing with BPD, experts must rule out similar-looking conditions, particularly bipolar disorder. That said, co-occurring disorders like depression, anxiety disorders, substance abuse, and eating disorders are high among people with BPD.
Treatment for Borderline Personality Disorder
One considerable challenge to seeking treatment: “People with [BPD] don’t often suspect they have it,” says Dr. Samuels. They might be seeing a therapist or doctor with another concern, and a diagnosis of BPD may surprise them.
A mental health expert can help treat BPD using a method called dialectical behavior therapy, which is “a cognitive behavior therapy treatment at its core, with some additional pieces added in,” says Dr. Hartstein. For example, dialectical behavior therapy may really zoom in on mindfulness, emotional regulation, and understanding healthy forms of validation.
When treating BPD, a main focus is for the patient to find acceptance of themselves while also promoting healthy changes. “We’re balancing this idea of accepting people where they are and pushing them to change, and that difference in this treatment has been shown to be really effective,” says Dr. Hartstein.
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(tranquil hip-hop music)
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-: A person with borderline, if I'm interacting with them,
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I don't always know where I stand.
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Am I the good person today?
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Am I the bad person today?
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Do you like me?
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-: So borderline personality disorder
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is a personality disorder
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where the person is somewhere between neurosis,
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so just like kind of a person
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that's typically worried about lots of different things,
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and psychosis, where a person is out of touch with reality.
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-: Some common ones are intense irregular mood shifts,
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engagement in self-harm or having suicidal thoughts,
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fear of abandonment, struggles with relationships,
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a chronic sense of loneliness.
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Some of those are really pervasive for some of these people.
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-: People with borderline personality disorder
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oftentimes have really unstable relationships
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because they see things in black and white
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or all or nothing.
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They might see their best, best friend
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and their worst, worst enemy,
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and it makes it really hard
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to maintain a meaningful relationship.
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-: They can get involved in all sorts
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of dysfunctional behaviors
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involving alcohol or drugs or spending or sex,
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have dissociative episodes
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where they are really out of touch with reality,
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and so it's a very tricky personality disorder.
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-: So, a lot of the symptoms
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of borderline personality disorder overlap
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with symptoms of other mental health disorders,
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and you really have to look at the specific symptoms
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of each of those other disorders
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that you might be considering,
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and you'll see that they don't quite match up.
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So, people with bipolar disorder, for instance,
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are gonna have major depressive episodes
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that fit with specific diagnostic symptoms,
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and they're also gonna have manic episodes
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that fit with other specific diagnostic symptoms
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that are not fully in keeping
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with what borderline personality disorder looks like.
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People with borderline personality disorder
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don't often suspect that they have it,
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so they might be going to a therapist or a psychologist
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or psychiatrist for some other question or concern
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and it might be revealed during that evaluation
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that borderline personality disorder is a concern.
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-: The most effective known treatment
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for borderline personality disorder
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is a treatment called dialectical behavior therapy,
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which is a cognitive behavior therapy treatment at its core
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with some additional pieces added in
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like real hardcore mindfulness training
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and really learning about validation
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and problem-solving and change strategies
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so that you can really recognize
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that the person is doing the best they can.
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So, we're balancing this idea of accepting people
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where they are and pushing them to change,
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and that difference in this treatment has been shown
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to be really effective and decreased self-harm
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and decrease suicidality
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and increase ability to regulate emotion.
Borderline personality disorder. Arlington, VA: National Alliance on Mental Illness. (Accessed on March 28, 2018 at https://www.nami.org/learn-more/mental-health-conditions/borderline-personality-disorder.)
Borderline personality disorder. Besthesda, MD: National Institute of Mental Health. (Accessed on March 28, 2018 at https://www.nimh.nih.gov/health/topics/borderline-personality-disorder/index.shtml.)
Borderline personality disorder. Washington, DC: U.S. National Library of Medicine. (Accessed on March 28, 2018 at https://www.ncbi.nlm.nih.gov/pubmedhealth/PMHT0024790/.)