By Kayt Sukel
In the bestselling memoir, Girl Interrupted, Susanna Kaysen chronicles her experiences after being diagnosed with borderline personality disorder (BPD), both inside and outside a psychiatric hospital. The subsequent movie, with an Oscar win for Angelina Jolie, shined a light for a time on BPD. But even though popular culture has become more familiar with mood and anxiety disorders, many people still aren’t quite sure what BPD is.
Madeleine Wilson, a clinical social worker who works with BPD patients in Albuquerque, New Mexico, says that many people are confused about what BPD is —especially since it so commonly overlaps with depression or anxiety disorders. But it is a separate mental health condition and causes a great deal of suffering and anguish for those who have it.
“BPD is considered a personality disorder. And what differentiates personality disorders from anxiety and mood disorders is that, traditionally, they are seen as more of a constant pathology,” she says. “Personality disorders don’t ebb and weave over time. They are part of an individual’s every day existence and affects how they interact with the environment, how they handle interpersonal communication, and alters the way they view themselves and others.”
Hallmark symptoms of BPD include impulsive behavior, problems regulating emotions, negative thinking, self-harming behaviors and unstable personal relationships. Some individuals with a severe form of the condition may even suffer from psychosis, which occurs when someone loses touch with reality. And, Wilson agrees, many people with BPD also have problems with depression and anxiety, as well as other mental health conditions, too.
“A person with BPD typically has escalated symptoms, symptoms they cannot regulate, on a pretty constant basis. They have a really extreme self-loathing that is often beyond what you see in typical depression,” she says. “Their distress tolerance really is at zero. They are typically very sensitive people. And they really are suffering in their own skin.”
While scientists are still studying the underlying causes of BPD, most agree that it is likely the result of both biological and genetic factors. But, in her practice, Wilson says many of her BPD patients have been the victims of childhood trauma. “Many patients are born into incredibly invalidating environments, which exacerbate their symptoms because they were likely born with a different way of processing stimuli in the environment in the first place,” she says. “And then if they experience trauma, it just all comes together in a terrible way. It’s a horrible way to exist.”
Current treatments for BPD include psychotherapies like dialectical behavioral therapy (DBT) and some patients will receive medication along with psychotherapy depending on their symptoms. But Wilson says that what people with BPD may require most is understanding and compassion. “We are very quick to judge people who live with BPD. We think of them as acting out on purpose, that they are crazy, that they are trying to get attention, that they are maliciously manipulative, that they are chameleons,” she says. “And while it is understandable why we view this disorder this way, we need to understand this is a condition where individuals are constantly undergoing a very personalized attack on themselves. And, we can’t help individuals with BPD work to get better until we recognize that.”