Borderline Personality Disorder

What Is Borderline Personality Disorder?

Clients with Borderline Personality Disorder (BPD) typically experience difficulties in five domains. First, clients with BPD generally experience emotional dysregulation and instability, as characterized by high emotional sensitivity, reactivity, and a slow return to one’s emotional baseline. Individuals with BPD often have difficulties with episodic anxiety and depression as well as problems with shame, anger, and anger expression. Second, individuals with BPD have patterns of behavioral dysregulation typically seen as impulsive behaviors. Suicidal and non-suicidal self-injurious behaviors (e.g., self-cutting) are relatively common. Drug and alcohol use, disordered eating behavior, and risky sexual behaviors are also common and are often behavioral attempts to regulate emotions. Third, individuals with BPD often have interpersonal difficulties. Their relationships may be intense, chaotic, and some BPD individuals report feeling easily abandoned and lonely. Fourth, dysregulation of one’s sense of self is reported by individuals with BPD in that they feel confused about “who they are,” “what they feel,” and “what their goals are.” Fifth, cognitive dysregulation often exists when individuals with BPD are emotionally dysregulated. Extreme (e.g., all or nothing) thinking, paranoid ideation, or dissociation can occur and this is called cognitive dysregulation. There is considerable clinical heterogeneity in this diagnosis so individuals with BPD can present quite differently from one another. BPD is more common among women and is estimated to occur in 1.6% to 5.9% of individuals.

BPD is more common among women and is estimated to occur in 1.6% to 5.9% of individuals. The biosocial theory of BPD asserts that BPD develops through the transaction of biological and social factors over time. The biological factor is comprised of a biological vulnerability to emotions as well as an inability to effectively regulate emotions. A biological vulnerability to emotions includes high sensitivity to emotions, high reactivity to emotions, and a slow return to an emotional baseline. The social factor includes an invalidating environment. Invalidation from the social environment occurs when others communicate that what you are feeling, thinking, or doing does not make sense and is inaccurate or an overreaction. Individuals who are chronically invalidated learn to communicate their emotions in extreme ways and/or no longer trust their own emotional experience.

Borderline Personality Disorder (BPD) in Adolescents

For many years, BPD was considered controversial among persons below the age of 18 since personalities were “still forming” during adolescence. Over the past 15 years, however, it has become evident through clinical and epidemiological research that BPD does in fact exist before one’s 18th birthday. The research is very clear now that youth can in fact show signs and symptoms of BPD that appear similar if not the same as it does in adulthood (see BPD). Unfortunately, many child and adolescent-trained clinicians have not been well-trained to diagnose personality disorders and instead may apply another diagnosis which may result in the youth receiving the incorrect or insufficient treatment. The clinicians at CBC are well-trained and capable of making the diagnosis where appropriate.