Understanding Borderline Personality Disorder

Borderline Personality Disorder (BPD) is characterized as a pervasive, long-term pattern of significant interpersonal relationship instability, a distorted sense of self, and intense emotional responses. The diagnosis is complex, and much too often misunderstood–even within the mental health community.

Challenges Associated With BPD

People with BPD often struggle with pervasive feelings of emptiness, intense and unstable emotions, fear of abandonment, and identity disturbances.

• Emotions change rapidly. This emotional volatility can be difficult to manage as you swing from one extreme to another.
• The fear of abandonment can lead to struggles with boundaries and support.
• Splitting (where people view situations and others as all good or all bad) can lead to patterns of idealization and devaluation, which strains relationships.
• People with BPD are at higher risk for self-harm and suicidal ideation.
• BPD often co-occurs with other mental health conditions such as depression, anxiety, substance use, and/or eating disorders.

Understanding and addressing the unique challenges of BPD requires patience, empathy, and a tailored therapeutic approach. As a schema therapist, I approach BPD by delving deep into the underlying schemas and early maladaptive patterns that contribute to these challenges.

The Role of Schemas in BPD

People with BPD often struggle with pervasive feelings of emptiness, intense and unstable emotions, fear of abandonment, and identity disturbances. These symptoms can be traced back to specific early maladaptive schemas. Some of the most common schemas seen in those with BPD include:

• Abandonment/Instability: The perceived instability or unreliability of those available for support and connection. Involves the sense that significant others will not be able to continue providing emotional support, connection, strength, or practical protection because they are emotionally unstable and unpredictable (e.g. angry outbursts), unreliable, or erratically present; because they will die imminently; or because they will abandon you in favor of someone better.
  
• Mistrust/Abuse: The expectation that others will hurt, abuse, humiliate, cheat, lie, manipulate, or take advantage. Usually involves the perception that the harm is intentional or the result of unjustified and extreme negligence. May include the sense that one always ends up being cheated relative to others or “getting the short end of the stick.”
  
• Emotional Deprivation: The expectation that one’s desire for a normal degree of emotional support will not be met by others. The three forms of deprivation are nurturance, empathy, and protection. Includes notable absences of (a) attention, affection, warmth, companionship; (b) understanding, listening, self-disclosure, mutual sharing of feelings; or (c) strength, direction, and guidance.
  
• Defectiveness/Shame: The feeling that one is defective, bad, unwanted, inferior, or invalid in important respects; or that one would be unloveable to significant others if exposed. May involve hypersensitivity to criticism, rejection, and blame; self-consciousness, comparisons, and insecurity around others; or a sense of shame regarding one’s perceived flaws.

In individuals with BPD, these schemas tend to play out as follows:

• The abandonment schema causes people to cling to relationships or react dramatically to any signs of perceived rejection.
• The mistrust schema makes people defensive or avoidant in relationships.
• The emotional deprivation schema fosters chronic feelings of loneliness and emptiness.
• The defectiveness schema makes it difficult for people to accept themselves and even begin to form healthy relationships.

Practical Steps For People With BPD

1. Self-Reflection: Engage in self-reflection to understand your triggers and emotional responses.
   
2. Mindfulness: Practice mindfulness to stay grounded in the present moment and reduce impulsive reactions.
   
3. Boundaries: Build and maintain healthy relationships by setting boundaries and communicating effectively with others.
   
4. Self-Compassion: Develop a compassionate inner dialogue to counter the harsh self-criticism often associated with BPD.
   
5. Therapy: Commitment to a specialized treatment like Dialectical Behavior Therapy (DBT) or Schema Therapy can help reducing symptoms and creating meaningful change.

Final Thoughts

A diagnosis of Borderline Personality Disorder can be challenging, but it is not the end of the road. By addressing the deep-rooted schemas that drive emotional instability and relationship difficulties, you can learn to cultivate a healthier, more fulfilling life.