Borderline personality disorder (BPD) is one of the most common personality disorders associated with the use of mental health services (Cotet, C.D., et al., 2017). However, it is also one of the least understood (Cotet, C.D., et al., 2017). For a long time mental health professionals even debated the very existence of BPD, given that many of its symptoms overlap with those of other mental illnesses.
Even today, many myths about BPD continue to persist. Some still believe that it is an illness that affects only women, while others might even believe that BPD isn’t an illness at all, and simply an excuse or call for attention (CBS News, n.d.). Fortunately, counsellors can help dispel these and other myths surrounding BPD, helping to reduce stigma and improve quality of life among those living with this mental illness.
Defining Borderline Personality Disorder for Students Taking Professional Counselling Training
Borderline personality disorder (BPD) is a subset of personality disorders that affects approximately 1 to 2 percent of the general Canadian population (CMHA BC, 2014). It is a disorder characterized by severe instability in self-identity and interpersonal relationships, as well as behavioural dysregulation, difficulty regulating emotional responses, and an array of comorbidities, or additional simultaneously-occurring diseases (Cotet, C.D., et al., 2017).
Researchers believe that BPD can result from environmental stress, neglect, and abuse, as well as biological factors such as the individual chemistry and activity of the brain (Psychology Today, 2018). While symptoms can vary depending on the individual, there are a few commonalities that appear with BPD, including unstable behaviour and emotions, difficulty maintaining relationships, an insecure sense of identity, and feelings of disassociation (CMHA BC).
Extreme depression, intense anger and apathy, and an inclination for ‘black and white’ thinking are often seen among those living with BPD. Additionally, more than 75 per cent of people who have BPD are estimated to engage in deliberately self-harming activities (Cotet, C.D., et al., 2017).
One myth about BPD is that this mental illness only affects women. Part of the reason why this myth endures may be because approximately 70 per cent of people diagnosed with BPD are women (CBS News, n.d.). However, mental health professionals know that men can also have BPD. In fact, many believe that this mental illness could be underdiagnosed in men.
Borderline Personality Disorder and Co-occurring Disorders
Many people living with borderline personality disorder also have another personality disorder or co-occurring mental illness (Harvard Mental Health Letter, 2006). In fact, experts note that “More than 90% of borderline personalities are also diagnosed with other personality disorders, especially avoidant, dependent, and narcissistic personality” (Harvard Mental Health Letter, 2006). In addition, many people with borderline personality disorder may also have another mental illness, such as depression, bipolar disorder, PTSD, or anxiety (Harvard Mental Health Letter, 2006). According to some statistics, “More than half suffer from major depression and more than three-quarters from an anxiety disorder at some time in their lives” (Harvard Mental Health Letter, 2006). Those with professional counselling training should also note that those living with BPD may also have an addiction or eating disorder (Harvard Mental Health Letter, 2006).
BPD and Relationships
One myth that continues to persist is that those living with BPD are incapable of forming close relationships with others. This myth can be especially hurtful for those living with BPD, as it reinforces stigma and social isolation. As those with a professional counsellor diploma know, while BPD can be challenging, it does not mean that those living with the condition cannot form close relationships. Mental health experts note that “people with BPD have a tremendous capacity for love and are often compassionate and caring towards humans and pets.” (CBS News, n.d.)
For those living with BPD, interventions such as Dialectical Behavior Therapy and Cognitive Behavioral Therapy can help with managing symptoms (National Institute of Mental Health, n.d.). Clients can learn how to experience a negative emotion without acting on it, so that worries about abandonment or jealousy are easier to manage in a healthy way (Saint Thomas, S., 2015). In addition, counsellors can help clients move away from extreme black and white thinking, which in turn can help them avoid idolizing or demonizing a loved one (Saint Thomas, S., 2015). Through these approaches, many people living with BPD can live full and rich lives, and enjoy close and healthy relationships with those they care about.
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Canadian Mental Health Association BC. 2014. Borderline personality disorder. CMHA BC. Retrieved from: https://cmha.bc.ca/documents/borderline-personality-disorder-2/
CBS News (n.d.) Borderline personality disorder: 8 dangerous myths. CBS News. Retrieved from: https://www.cbsnews.com/pictures/borderline-personality-disorder-8-dangerous-myths/
Choi-Kain, W.L., M.D., & Gunderson, J.G., M.D. (2018). Medication management for clients with borderline personality disorder. The American Journal of Psychiatry 175 (8). doi: 10.1176/appi.ajp.2018.18050576
Cotet, C.B., PhD., & Cristea, I.A., PhD., & Gentili, C., M.D., PhD, et al. (2017). Efficacy of psychotherapies for borderline personality disorder: A systematic review and meta-analysis. JAMA Psychiatry, 74 (4). doi: 10.10001/jamapsychiatry.2016.4287
Harvard Mental Health Letter (2006). Borderline personality disorder: Origins and symptoms. Harvard Medical School. Retrieved from: https://www.health.harvard.edu/newsletter_article/Borderline_personality_disorder_Origins_and_symptoms
Linehan, M.M. (2018). Cognitive-Behavioural Treatment of Borderline Personality Disorder. University of Washington Press. (pp 19 – 22).
National Institute of Mental Health (n.d.). Borderline Personality Disorder. National Institute of Mental Health. Retrieved from: https://www.nimh.nih.gov/health/topics/borderline-personality-disorder/index.shtml
Paris, J. (2018). Clinical Features of Borderline Personality Disorder. In Livesley, W.J., & Larstone, R. (Ed.), Handbook of Personality Disorders: Theory, Research, and Treatment (pp 419 – 424).
Psychology Today (2018). Borderline Personality Disorder. Psychology Today. Retrieved from: https://www.psychologytoday.com/ca/conditions/borderline-personality-disorder
Saint Thomas, S. (2015). What Is It Like to Date When You Have Borderline Personality Disorder? Vice. Retrieved from: https://www.vice.com/en_ca/article/9bgd93/what-is-it-like-to-date-with-borderline-personality-disorder-999
Statistics Canada (2015). Section F – personality disorders. Statistics Canada. Retrieved from: https://www150.statcan.gc.ca/n1/pub/82-619-m/2012004/sections/sectionf-eng.htm