Marsha Linehan said, “People with Borderline Personality Disorder (BPD) are like people with third degree burns over 90% of their bodies. Lacking emotional skin, they feel agony at the slightest touch or movement.” How did she have the audacity to make such a statement on behalf of her patients? As she revealed a few years ago, she had borderline personality when she was younger, which is probably part of the reason she was able to create an effective form of therapy for the condition (Dialectical Behaviour Therapy, DBT).

So a diagnosis of borderline personality means being emotionally sensitive, but what else does it mean? First of all, we want to acknowledge that the title of the diagnosis tells us little at all about what it actually means, and that labelling a personality as a disorder can be experienced as offensive and stigmatising. That said, we’ve worked with people who have found it incredibly useful to find a name for the difficulties they experience, so one size doesn’t fit all.

The criteria for fitting a diagnosis of borderline personality disorder are at least five of the following:

• Frantic efforts to avoid real or imagined abandonment.
• A pattern of unstable and intense interpersonal relationships characterised by alternating between extremes of idealisation and devaluation.
• Identity disturbance: markedly and persistently unstable self-image or sense of self.
• Impulsivity in at least two areas that are potentially self-damaging (e.g. spending, sex, substance abuse, reckless driving, binge eating). This does not include suicidal or self-harming behaviour.
• Recurrent suicidal behaviour, gestures, or threats, or self-mutilating behaviour.
• Affective instability due to a marked reactivity of mood — intense feelings that can last from a few hours to a few days.
• Chronic feelings of emptiness.
• Inappropriate intense anger or difficulty controlling anger.
• Transient, stress-related paranoid ideas or severe dissociative symptoms.

If you’re reading this and thinking that some or many of these criteria describe you, we recommend that you don’t self-diagnose, but instead talk to one of us, or another professional, about your concerns. The important thing isn’t a label or a diagnosis — it’s that there are many effective treatment options that can help make your life better. Don’t give up. It’s not uncommon for people to need to try a few different treatment options before they succeed.

Note: We don’t assess or diagnose people for BPD (or any other condition) — you can see a Psychiatrist for that.

What causes Borderline Personality Disorder? 

With the current state of research on BPD, anyone who claims to know the definitive answer to this question is being overconfident. However, clients we’ve worked with often find that the biosocial theory fits with their own personal experience.

Biosocial theory says that BPD is essentially a difficulty with emotional regulation, or maintaining good enough emotional balance. The “bio” part refers to the idea that people diagnosed with BPD may be biologically predisposed to feel emotions very strongly. In itself, feeling emotions strongly isn’t enough to produce BPD — the second part, the social aspect, is also required. This is an invalidating environment: circumstances, usually early in life, in which a person receives the message that their emotions are not valid or that they are unimportant. Trauma, various forms of abuse or neglect, or PTSD can contribute to this invalidating environment.

So that’s the theory of the set-up for BPD: strong emotions which have been repeatedly invalidated. However, there’s likely another component. Sometimes people’s circumstances are such that they only receive validation or support when they express themselves in an emotionally out-of-control way. In essence, these circumstances sometimes teach people to act “borderline,” because it’s actually an effective way — in the short term — of getting help or support. This can be important to understand, but this theory should never be used to ignore potentially dangerous behaviour, such as suicide attempts.

Is there hope for people with BPD?

In a nutshell, yes. Contrary to older beliefs about BPD, research shows that most people do achieve a lasting recovery from a diagnosis of BPD. However, there’s a catch: good recovery rates are only seen in people who receive psychotherapeutic treatment, and it takes time — usually years. Furthermore, not all treatments are equally helpful. For instance, standard Cognitive Behavioural Therapy (CBT), a popular form of therapy, typically doesn’t help in the long run for people with BPD, because it can feel too emotionally triggering and invalidating. ISTDP, Schema Therapy, Mentalisation-Based Therapy, and DBT have all been proven effective for BPD. The best results are achieved by working with a therapist specifically trained in one of these modalities. At Lucid Psychotherapy & Counselling, we have clinicians experienced and trained in ISTDP and DBT, who are experienced working with people who fit the criteria described above.