Borderline Personality Disorder (BPD) – Are YOU Borderline?

Shakespeare says the world’s a stage I’m ready to believe him Drama blasting from the past Now you really need it

Writhing in a deadly dance Life upon a razor I know that once you cut your wrist To see if you could feel it

Then all it once it all blows up In flaming, screaming faces Reality morphs and flows Those old familiar paces The band kicks into your favorite song And now we’re trading places

Make you, shake you, Any way they take you At the Borderline Ball tonight

Okay, so I’m not quitting my day job, but Borderline Ball (a poem I wrote in 1999) captures a psychological state of being called Borderline Personality Disorder. Therapists love this song, because it’s written about one of the most common and feared flavor of crazy, Borderline Personality Disorder (BPD). Borderline Personality Disorder is a complicated condition where people have unstable relationships, rapid shifts into rage and alarm, endless nasty dramas, and cycle in their attitudes towards loved ones from “You are the greatest” to “You are slime and deserve punishment.” Those with Borderline Personality Disorder (BPD) easily believe others are abusing them and want to get back, get even, and get theirs. All of Tony Soprano’s girlfriends were borderlines. You might recall that Tony glowed bigger than life for these wounded women in the beginning. Eventually, he didn’t pay enough attention to them, or wouldn’t leave his wife (or didn’t call, or said the wrong thing—borderlines are easily offended), and they became enraged and began acting out with dramatic attacks. They called Carmela, had screaming fits, attempted suicide, or threw steaks in his face. And because Tony had a lot of psychopath in him (he enjoyed doing violence to others), he got really scary when they went after him or his family.

Borderlines can be low-functioning, moderately functioning, or high-functioning.

• A low-functioning borderline has trouble keeping jobs (too much personal conflict and drama), is an ongoing risk for suicide, self-mutilation, and stalking, and is likely to have been institutionalized. Think Glen Close in Fatal Attraction.
• A moderately-functioning borderline can have what looks like a normal life until some traumatic restimulation cues the drama—but the drama is confined to screaming, leaving, or insulting without bodies being hurt or lives being ruined. Low and moderately functoning BPD’s can look pretty normal when reciting lurid stories about being victimized, abused, or neglected, and often recruit others to join them in hating the object of their ire.
• A high-functioning borderline can mostly catch losing it and get a hold of themselves, ask for help, eventually work through problems with intimates, and consciously strive to do no harm.

Most of us have some borderline traits.

If given the right stressors, we can have delusional beliefs and vicious impulses. I get pretty vindictive when I observe corruption injuring people—I become self-righteous and angry, crave violent justice, and struggle for compassion. Borderline traits saturate extreme politics, where incredible lies are told, and vast suffering is wished upon groups and individuals who arent’ “us.” According to Bateman and Fonagy in their wonderful book, Psychotherapy for Borderline Personality Disorder, borderlines are 0.2 to 1.8 percent of the general population; 8-11 percent of outpatient therapy clients; 14-20 percent of hospitalized clients; and a whopping 60-80 percent of forensic populations (criminals, mostly men). This might explain why clinicians diagnose BPD more with women—hundreds of thousands of borderline men are in jail.

What Causes Borderline Personality Disorder (BPD)?

The general consensus seems to be that BPD is likely to show up in kids who suffer from severe neglect and/or abuse starting before two, and who go on to have a childhood without a parent who attunes well and provides some balance of love and limits. If a child is born highly emotionally reactive, the chances go up. One of the warning signs that a person may have BPD is if he or she tends to have a lot of trouble managing anger, and regularly seems to snap into a hurting/raging state. While stuck in this state, a person with BPD feels compelled to attack a friend, lover, or family member whom they believe has wronged them (and often themselves physically in the form of self-mutilation or other angry, risky behavior). They will actively hurt others, or feel entitled to abandon others (without really leaving, since they usually come back for more drama). Borderlines enter angry states characterized by overwhelming impulses to attack verbally—sometimes physically—where they can say and do outrageously nasty things that look ridiculously insensitive and distorted to others, but make sense to them. The borderline, in fact, is the abuser in most situations, who secretly gets off hurting people she’s mad at—an insight borderlines fight to not have. In therapy sessions, just informing a low-functioning borderline that she is being abusive to someone is likely to result in her going crazy right before your eyes (often as she starts to go after you). Of course, normal people lose it once in a while, saying or doing things in anger that they don’t really mean or intend. If you point this out to normal people, however, they’ll stop and think for a moment, and usually become embarrassed and start apologizing and making efforts to lighten up. Normal people are better at adjusting thoughts, feelings, conversations, and actions to be more empathic and compassionate. But when you press BPD sufferers about this stuff, they go crazy. Their raging can intensify and become truly scary. It’s hard to know what to say or do in the face of such fury, because if you try to relate in a rational manner to a borderline who is upset, they’re likely to go further off the deep end and do their utmost to drag you down with them. My friend Janet Loxley once told me, “Keith, the two ways you know you’re dealing with a borderline is that you feel bad about yourself after contact with them, and you fight with other people about them. One reason we tend to feel bad about ourselves after dealing with a borderline is that he or she often subtly projects danger lurking around the corner and you’re a selfish person if you can’t sacrifice for them. For example, “I might have killed myself if I hadn’t reached you,” implies “You’d better be there or I might kill myself.” One reason people fight with each other about borderlines is that borderline stories make other people look like they’re abusive. It’s unpleasantly icky to discuss possible abuse, causing such discussions to become defensive arguments. These battles are a lose/lose for everyone—but most of all for those with BPD. They need help, not more drama.

Am I a borderline?

If you have unstable relationships, find it difficult to control your anger, and frequently attack the people you’re closest to, don’t panic! This doesn’t necessarily mean you have BPD, because relationships are difficult and most of us lose our tempers occasionally. On the other hand, you can check yourself for other BPD signs in a sort of psychological self-administered breast exam. Ask yourself these questions:

• Do I engage in self-destructive behaviors like addictions, self-mutilation, eating disorders, or emotional explosions?
• Do I regularly feel victimized by others?
• Do I believe people need to be punished for hurting me, and do I talk myself into saying or doing mean things because I self-righteously believe that person deserves it?
• Does the world feel like a malevolent place—out to get me—and do I feel like a helpless child in it?
• Through my life, have I had a pattern of loving or admiring someone, and then hating and attacking them harshly when I feel hurt or let down?

If you find any of the above happening to you on a chronic, regular basis, I advise you to find a therapist skilled in the kind of therapy that focuses on your states of consciousness.  In America, this is often called Dialectical Behavior Therapy or Acceptance and Commitment Therapy; in England researchers like Bateman and Fonagy call it “Mentalization-Based Psychotherapy.” All these therapies focus on regular treatment centered around awareness of extreme states and abilities to soothe yourself and reach for compassionate truth instead of angry distortions. Some studies show that when those with BPD commit to this kind of therapeutic work, one-third of them have recovered two years later (meaning they are no longer diagnosed with BPD); one-half are recovered four years later; and over two-thirds are recovered six years later, with only 6 percent reverting to BPD behavior. These are astonishingly successful statistics. One of the reasons I love psychotherapy is because it can help people with debilitating habits of crazy feelings, thoughts, and actions recover. Such work is life-changing, life-affirming, and ultimately gratifying for therapists (though it can be a rocky ride—let me tell you). And these stats also show how borderlines need not believe that they are condemned to a lifetime of trauma and misery—if they commit to grow, they can have the joy and love all of us need and deserve.