Borderline Personality Disorder

Borderline Personality Disorder (BPD) has quite the history. Current research shows that when interacting with mental health professionals, a diagnosis of BPD leads to high levels of stigma. Higher than any other diagnosis! The entire idea of a personality being “disordered” is itself pretty weird, and in some ways, a problematic thing to internalize. At the same time, being able to label this cluster of “symptoms” that we identify as BPD – such as rapid emotional swings, unstable interpersonal relationships, impulsive behaviour, and unstable self image – have led to advances in understanding and treatment.

Modern theories of why BPD exists tend to centre on attachment systems – the part of your brain responsible for monitoring the people who are important to you and making sure they stay close. Our brains adapted in an environment where keeping others close was essential to our survival. They are wired to panic and set off alarm bells when we think we might end up alone. These responses can lead to a sudden escalation involving huge outbursts or an inward spiral, leading to emotional shut downs, avoidance, and numbness. With folks who fall into the “BPD” category, these responses tend to be, well, bigger. Perceived threats to our attachment – to the people we care about, and sometimes even people that we are casually acquainted with – can lead to splintering of your normally rational brain.

Neurologically, the attachment system hangings out in what we call the mid-brain – an older structure that we share with mammals, such as dogs and cats. The mid-brain is concerned with survival and basic emotions. When it is triggered, the mid-brain takes over and starts shutting down the prefrontal cortex (where all of our fancy rational thinking occurs). This works great if the threat is a charging bear. This becomes a problem when we think there’s a threat because someone we love didn’t text us back.

Treatment for BPD involves various strategies. The core aim is to help you learn to recognize the big emotional states and swings, step back, regulate your emotions, and use new behaviours that are in line with who you are. There are a lot of different pieces involved in doing this. Mindfulness helps build up parts of our brains that facilitate stepping back and impulse control. Cognitive strategies help us learn to recognize the ways our thoughts become unbalanced, while narrative strategies help us write new, helpful stories about ourselves. Grounding strategies help us get back in touch with the moment in order to re-balance the brain when it’s getting away from us.

The central component is emotional acceptance. Using specific skills, we learn to approach the painful emotions that we don’t want to feel and see them with compassion and acceptance. It’s okay that parts of us are hurt, but this doesn’t mean that painful emotions get to run the show. As we lean into these painful emotions, we gain insight into what these parts actually need: safety, security, love. We can figure out whether there are new, creative ways to help these distressed parts of ourselves settle down, and how to exist alongside them.

Working with folks with BPD, I have often noticed a clear awareness between the lives they want to lead and the behaviours that throw them off track. The neat thing is that brains can change with consistent effort – and the right tools. It’s a process, and it takes a lot of work. Therapy can help you get there.