May is Borderline Personality Disorder Awareness Month! Stacy Pershall, a member of the Active Minds Speakers Bureau who has a diagnosis of BPD, shares 5 things you should know about this oft-misunderstood disorder. Bring Stacy to your campus to speak today!
1. The disorder got its name from psychoanalyst Otto Kernberg, when Freudian therapists observed that people with BPD “came apart on the couch” and theorized that they were on the borderline between neurosis and psychosis. Now that we know more about psychology than we did in the 1960s (thank goodness), therapists have suggested renaming BPD something more accurate and with less stigma attached. Suggested names include “Emotion Dysregulation Disorder” and “Complex PTSD”, as people with the disorder have often experienced early trauma.
2. People with BPD are not intentionally manipulative, even when they do things like threaten suicide if you leave. They might know that such behavior is perceived as manipulative, but that doesn’t help a person with untreated BPD control the impulse to avoid abandonment in the moment. What you perceive as manipulation comes from fear, with anger as a secondary emotion.
3. BPD is often misdiagnosed as bipolar disorder due to the intense mood swings present in both. Bipolar disorder is more common, affecting 2.6 percent of the diagnosed U.S. population, while BPD affects 1.6 percent. However, due to frequent misdiagnosis, these numbers may be misleading. Accurate diagnosis depends on recognizing a trend of situation-dependent mood swings (often in response to relationship issues) vs. those not precipitated by circumstance.
4. There’s concrete brain science validating the existence and refining our understanding of BPD. Evidence points to malfunctions in the limbic system, which controls emotional intensity, and the subgenual anterior cingulate, which controls emotion regulation. Learning skills to improve the latter helps moderate the former.
5. We can recover, because there’s effective treatment now. The gold standard is dialectical behavior therapy, created by Marsha Linehan, but there’s also mentalization-based therapy, schema therapy and transference-focused psychotherapy.
A brief rundown of the differences: DBT focuses on mindfulness and has been described as “Thich Nhat Hanh meets tough love”. Mentalization-based therapy focuses on helping people with BPD recognize boundaries between their emotions and the emotions of others.
Transference-focused psychotherapy uses the relationship between client and clinician to create a safe environment for boundary testing. Schema therapy draws from all three to help clients identify and change the erroneous thoughts that lead to extreme behaviors.
If you or someone you love has been diagnosed with BPD and cannot yet access treatment, you should know about these