Borderline Personality Disorder: Expectations Vs. Reality

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Borderline personality disorder (BPD) is a condition that is often misunderstood. For young adults especially, hearing that they might have BPD can be frightening and they may have preconceived expectations of what that might mean. However, all those who have BPD experience the condition differently, and assumptions can often be wrong.

Symptoms and Diagnosis of Borderline Personality Disorder

There are several symptoms of borderline personality disorder that must be present for a diagnosis, including:

  • Desperate efforts to prevent being abandoned
  • Impulsivity
  • Self-harm and suicidal ideation
  • Swift and dramatic mood swings
  • Splitting – a pattern of idealising other people and then devaluing them
  • A distorted self-image

These are only some of the symptoms of BPD, and each symptom can look different in each individual. Young adults must present five of nine symptoms to be diagnosed with BPD, and many combinations can appear. One person’s experience of BPD can be vastly different to anothers and there is no right or wrong way to have it.[1]

Expectations Vs. Reality

Borderline personality disorder is surrounded by myths and false expectations. Many people have a false image of BPD that can create prejudice and judgement, but much of what makes up that image is not all that it seems.

Types of BPD

Many people expect young adults with borderline personality disorder to be the same, suffering from extreme mood swings, intense anger, and struggling to maintain relationships. While some may be like this, there are four types of BPD that look very different and can change how symptoms present. These four types are:

  • Petulant – people with petulant BPD can struggle with intense mood swings and be more irritable, impatient, and stubborn than those with other types.
  • Discouraged – also known as quiet BPD, those with this form of BPD try to hide their emotions and come across as clingy or codependent despite feeling incredibly lonely.
  • Impulsive – those with impulsive BPD often experience more self-destructive and aggressive behaviours, such as using illegal substances and getting into physical altercations.
  • Self-destructive – people with self-destructive BPD may struggle with intense self-hatred, and cover up their emotions with risky activities, self-harming, and substance abuse.

Depending on the type of BPD, the same symptoms can be very different. For example, someone with impulsive BPD and someone with discouraged BPD may both experience mood swings, but the person with quiet BPD directs them inwards, while the person with impulsive BPD may become more aggressive and abuse substances to cope.

Causes of BPD

Some think that BPD is caused by childhood abuse. This misconception can be harmful to the families of those with BPD as well as the person with BPD. Although child abuse can contribute, not all those with BPD have experienced it. Other causes of BPD may include:

  • Genetics – there is evidence that genetic factors can play a role in the development of BPD. One study has found that a gene that controls the brain’s use of serotonin could be related to BPD.[2]
  • Biology – differences in brain structure may cause BPD, with one study associating BPD with excessive activity in the part of the brain that controls the expression and experience of emotion.[3]
  • Environment – environmental factors such as the death of a parent may influence the development of BPD.

There is no one cause of BPD. It is believed that both biological and environmental factors cause it.

BPD and Bipolar Disorder

The symptoms of bipolar disorder and BPD are similar, so some people may expect they are the same condition and present in the same way; however, they are both very distinct from one another.

The symptoms of bipolar disorder that are similar to BPD are:

  • Extreme mood swings from manic or hypomanic to depressive
  • Self-harm in depressive episodes
  • Risky behaviour and impulsivity in manic episodes

Despite these similarities, the two conditions are not interchangeable. Many people with BPD are often misdiagnosed with bipolar disorder, which impacts their treatment and adds to the confusion between the two.

Gender and BPD

Although many people with BPD are women, men can also suffer from BPD, though the ratio for women does seem to be higher.

It is unknown why this is, but some think it is because of a sampling bias, with more women seeking treatment for their symptoms.[4] It may also be the case that more women internalise their symptoms and that more men are diagnosed with antisocial personality disorder rather than BPD.

Next Steps

If you or a young adult in your life has been diagnosed with BPD, it can be hard to know what to expect next. BPD can be difficult to treat, as people may react badly to treatment. They may:

  • Refuse to comply with treatment – young adults with BPD may resist treatment as they see other people, not themselves, as the problem. Alternatively, they may view themselves as unworthy of help and therefore think they do not deserve treatment.
  • Engage in self-destructive tendencies – engaging in treatment requires those with BPD to see that they need to change, increasing issues with self-harm which can complicate treatment.
  • Struggle with relationships – when in treatment, those with BPD will receive therapy, which can lead to relationship issues with their therapist. They may idolise them then demonise them (splitting) and therapists must be trained for this.

Despite the issues that can arise, young adults diagnosed with BPD can engage in treatment. There is an excellent prognosis with BPD and most of those diagnosed go into remission.

Residential treatment is often the best choice for young adults with BPD. In this setting, they can focus on healing and attend a range of therapies such as dialectical behavioural therapy (DBT), group therapy, and art therapy. The Wave is here to help. We provide stellar residential care for all young adults who come to stay with us.

Conclusion

There are many false expectations of BPD. In truth, nothing can be expected from this condition – it can present differently in each individual, and each person will respond differently to treatment.

Contact The Wave today for more information about how we treat BPD. We understand that each individual will have a unique experience of this condition, which is why our team of expert clinicians creates a unique plan for them.

Sources:

[1] Shim IH, Woo YS, Bahk W-M. Prevalence rates and clinical implications of bipolar disorder “with mixed features” as defined by DSM-5. Journal of Affective Disorders. 2015;173(1):120-125. doi:10.1016/j.jad.2014.10.061

[2] Maurex L, Zaboli G, Ohman A, Asberg M, Leopardi R. The serotonin transporter gene polymorphism (5-HTTLPR) and affective symptoms among women diagnosed with borderline personality disorder. Eur Psychiatry. 2010;25(1):19-25. doi:10.1016/j.eurpsy.2009.05.001

[3] Ruocco AC, Carcone D. A neurobiological model of borderline personality disorder: Systematic and integrative review. Harv Rev Psychiatry. 2016;24(5):311-29. doi:10.1097/HRP.0000000000000123

[4] Skodol AE, Bender DS. Why are women diagnosed borderline more than men? Psychiatr Q. 2003 Winter;74(4):349-60. doi: 10.1023/a:1026087410516. PMID: 14686459.


Fiona Yassin is the International Clinical Director of The Wave Clinic. Fiona is a UK Registered Adolescent and Family Psychotherapist and Clinical Supervisor (Licence number #361609 NCP/ICP), further trained in the specialty of Eating Disorders and Borderline Personality Disorder Treatment. Fiona is trained in FBT (Family Based Therapy), CBTE for eating disorders, FREED (King’s College, London), EMDR for eating disorders (EMDRIA) and has a Post-Graduate Diploma in Neuroscience and Trauma from the University of Tennessee, Knoxville.

Fiona works with international families and family offices from the UK, Dubai, Kuwait, Singapore and Malaysia. Fiona can be contacted by email on [email protected].

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