Having borderline personality disorder (BPD) means struggling to regulate your emotions. If depression sucks the colour out of the world, then BPD turns it right up until it’s painfully bright. If you have BPD then you’ll react in intense ways to emotional triggers: You might get the wrong coffee order, and your inner monologue starts telling you that you were given a mocha instead of a latte because you are a bad person. It means your relationships are often intense and unstable – this is such a key part of the disorder that it’s part of the diagnosis. You might spend money impulsively, and your friends might find you overly generous with your gifts. It can also be frequently misdiagnosed but, when it is identified, people with BPD are often labeled as “difficult”. This labeling and stigmatization of the disorder can feed into the looming fear of abandonment that is a cornerstone symptom of BPD. BPD can lead to a very unstable existence. In the UK, where our BPD star Sophie is from, it’s actually called emotionally unstable personality disorder, or EUPD. Sophie is telling us her story, and how her BPD makes her hyper-attuned to the emotions of others. We’ll find out how BPD can be a defence mechanism by a brain that’s been through trauma, and we’ll learn about how it’s treated. We’ll hear from a doctor who knows what’s going on in the brain and can tell us about how people can get better. Treatment is a lot of work, with a lot of talking. Our doctor knows how and why the different treatments out there are effective, and Sophie’s been through the process. This is a condition that remits and recovers. One of the features that defines recovering is being in a stable relationship, of any kind.
Diagnosis of personality disorders in youth is relatively new. Before the release of the Diagnostic and Statistical Manual, version 5 (DSM-V), nobody under the age of 18 could receive a diagnosis of a personality disorder, mainly due to the transitional nature of personality in youth, and the degree of stigmatization attached to such a diagnosis. Researchers have since stressed the importance of early detection and treatment for the outcomes of these disorders. In fact, almost all personality disorders diagnosed in adulthood can also be diagnosed in children under the age of 18 who have presented with symptoms for at least one year. The one exception to this rule is related to the diagnosis of antisocial personality disorder in adulthood, which must be preceded by a history of childhood conduct disorder.
This episode’s guest, Sophie, mentions different ways her symptoms of borderline personality disorder (or BPD) influence her relationships and ability to trust. We hear that having BPD has instilled in her a tendency towards hyper-attunement to others. This means that Sophie connects to and takes on the emotions of others, in such a way that impacts her behavior and relationships – sometimes in good ways, and sometimes in not-so-good ways. Sophie shares with us that she often identifies and latches on to a “favorite person”, which can sometimes introduce problematic coping mechanisms when things go awry. We also learn about Sophie’s difficult struggles with trust and distrust towards other people and situations.
Often common in those afflicted with BPD, researchers have been prompted to explore the link between impairments in trust processes and the disorder. One study suggests that developmental factors, like experiences of emotional neglect or a lack of trust in parents during childhood, may influence certain behaviors in interpersonal exchanges and ultimately be a risk factor for trust issues in adults with BPD. With the involvement of trust processes being so salient in those with BPD, special attention needs to be attributed to ensuring a safe and trustworthy therapeutic alliance can be established between the therapist and person that is seeking treatment for BPD. Folks with BPD have expressed that therapy simply doesn’t work for them when they are made to feel unsafe. Because of this, care providers are encouraged to consider difficulties with trust in individual treatment plans and emphasize interpersonal trust between themselves and the person seeking treatment for BPD with the goal of developing a favorable therapeutic alliance.
Fast Facts
Learn More about This Episode’s Cool Researchers
As mentioned in the episode, borderline personality disorder is a much-stigmatized condition. For example, one study found that the word “difficult” can routinely be used by clinicians to label a person with BPD. Breaking through these labels and stigmas, while recognizing the need to establish safety and trust through the therapeutic alliance, many clinicians are providing compassionate care towards those with a BPD diagnosis; one such person is this episode’s expert guest, Dr. Brandon Unruh.
Dr. Unruh is disrupting the status-quo of care for BPD by examining and targeting how the next generation of clinicians are being taught about the disorder. In terms of treatment, Dr. Unruh and his colleagues focus on specialized evidence-based treatments for BPD, like dialectical behavioural therapy (DBT), mentalization-based treatment (MBT), and transference-focused psychotherapy (TFP). Dr. Unruh is particularly interested in MBT which is based on the theory of failed mentalization for BPD and refers to impairments with identifying mental states, like attitudes or feelings, in oneself or in others along with difficulties in recognizing how these mental states are influenced by each other. To improve the process of mentalization, MBT emphasizes mental states and interpersonal interactions by encouraging individuals with BPD to focus on how their own mental states affect their own behavior, and the behavior of others. Much of Dr. Unruh’s research on BPD treatment focuses on this method, including an interesting case study on the use of MBT in treating a physician struggling with BPD.
Support
If you’re struggling with your mental health, you’re not alone.
If you are in immediate danger of harming yourself or others, call 9-1-1, or head to your nearest emergency room. You can also call or text 9-8-8 to reach the Suicide Crisis Helpline. Support is available 24 hours a day, 7 days a week.
Young people can chat anytime with Kids Help Phone by calling 1-800-668-6868. Services are available in English and French.
Wellness Together Canada provides one-on-one counselling, self-guided courses and programs, and peer support and coaching. Youth can contact this service by calling 1-888-668-6810 or texting WELLNESS to 686868. Adults can contact this service by calling 1-866-585-0445 or texting WELLNESS to 741741. You can also find credible articles and information on their website.
The Canadian Mental Health Association can help you find resources, programs, or support for yourself or others. Find a CMHA branch in your area here.
The Centre for Addiction and Mental Health provides Mental Health 101 tutorials and online courses on their website.
Though not nation-wide, the Borderline Personality Disorder Society of British Columbia provides support and resources to those struggling with BPD.