Down the Rabbit Hole of Borderline Personality Disorder
Second-year Psychology students participating in the University Honours College follow a workshop on Blogging Science, in which they learn to communicate science to the general public, by means of informing, giving an opinion, and relating issues in science to issues in society. This year a selection of these written blog posts is published on Mindwise. Today’s post is by Juliana Nimz.
Little Alice fell down the Hole, bumped her head and bruised her soul
– Carroll, L. (1865)
The world of Borderline Personality Disorder (BPD) can be hard to access as an outsider. BPD is a complex illness altering cognition, perception and affect – so, essentially, everything that defines who we truly are. One can imagine it is like living in a parallel universe, some kind of Alice’s Wonderland, where everyday laws and simple logic do not apply. BPD entails unstable relationships, impulsivity, feelings of emptiness and anger, and dissociation, as well as psychosis (Krawitz & Jackson, 2008). Individuals often engage in self-harm in an attempt to cope with the emotional pain. Neglect during childhood, like abuse and emotional deprivation, are common to precede the development of BPD. How can living with these bumps on your head and bruises on your soul be imagined as a mentally healthy individual, you may ask? Well, let’s go through the most debilitating symptoms, followed by how to deal with them.
Emotional instability, meaning a highly reactive affect, has been classified as the most crippling feature of BPD (Chapman & Gratz, 2007). This manifests itself as poorly modulated emotional responses, which are often inappropriately extreme. Social interactions become difficult due to the inability to regulate, understand and express emotions adequately. Emotional instability can ultimately lead to self-harming behaviour, social isolation and increased aggression. As social beings, meaningful interactions with other humans are essential to our health. An inability to form these connections and maintain them, due to emotional problems, reduces the quality of one’s life enormously. Birthday parties, zoo visits, having a chat about anything and everything with your best friend? All these become a challenge, in which you are constantly trying to understand other people’s emotions, while keeping your own emotions in check.
Individuals with BPD find it hard to control their anger and irritation (Chapman & Gratz, 2007). This results in risky and reckless behaviour, lacking reflection. Extreme irritability, anger and impulsivity can be led back to a malfunctioning serotonin system, which is often sluggish in BPD (Krawitz & Jackson, 2008). The neurotransmitter serotonin is responsible for mood stability, cognition and sleep regulation. Childhood abuse predicts higher levels of impulsivity (Kolla, Meyer, Sanches & Charbonneau, 2017). Estimations suggest 70% of BPD cases report a history of sexual abuse, scarring people for life and increasing their levels of impulsivity. It has been shown that a history of abuse and the resulting trauma, can add to genetic risk factors and elicit the onset of BPD.
Cognition in BPD is altered in an interesting way, which enforces “black-and-white thinking”, referring to thinking in absolutes (Krawitz & Jackson, 2008). An example of this is that people with BPD find it hard to incorporate that people can have both desirable and undesirable traits. This leads to the splitting of social contacts into two personas. Specifically, one persona is put onto a pedestal and idealised, whereas the other is demonised and devalued frequently. This splitting aggravates and destabilises social relationships, as it is often hard to understand how a BPD sufferer can switch from idealising to devaluating so rapidly. This may be hard to understand as a healthy individual, as it is unimaginable how obsessive sufferers become with the hatred they feel towards someone that has rejected or abandoned them. Even though individuals recognise how self-destructive this behaviour is, it is extremely challenging for them to see people as sometimes good and sometimes bad.
Dissociation is common for individuals with BPD and is characterised as intrusions into awareness and behaviour, and zoning out (Scalabrini, Cavicchioli, Fossati & Maffei, 2016). This can be imagined as having a “foggy mental state” (Chapman & Gratz, 2007), meaning being unable to access information or to control thoughts and actions, that are usually easy to control. Severe dissociation has been found in 26% of people with BPD. In response to traumatic flashbacks, dissociation may serve as a distraction from emotional turmoil (Chapman & Gratz, 2007), leading to stress relief. One can easily recognise how disabling this can be: How would it be like to live with constant reminders of horrible situations, that you have experienced?
With regard to comorbidity, substance abuse has been found in approximately 20% of the BPD population (Chapman & Gratz, 2007). This abuse can help individuals avoid and escape emotional pain. As people with BPD tend to be more emotionally extreme, they tend to engage in more substance use in order to deal with their emotions. However, substance use is not an effective way of coping with strong emotions. In addition, the effects of the substance are seldomly long-lasting. The resulting damage of substance abuse remains and complicates their life further.
Additional frequently co-occurring disorders in BPD are eating disorders. Around 50% of BPD individuals suffer from disorders such as anorexia nervosa or bulimia nervosa (Chapman & Gratz, 2007). Similar to substance abuse, bingeing food can be seen as a way of relieving negative emotions. Furthermore, restricting one’s diet can provide individuals with a sense of control, which is often missing in everyday life with BPD due to their emotional struggles.
Dealing with BPD
It is evident that BPD massively impacts everyday functioning enormously. Challenges can arise in social interactions, due to increased impulsivity, emotional instability, splitting and psychosis. Internal difficulties due to dissociative episodes, comorbid disorders or self-directed aggression also compromise the quality of everyday life. Simple things like meeting for a drink with friends or going grocery shopping can become real struggles, which consume high amounts of energy, due to the difficulties with social settings and emotional regulation. In addition, the stigmatisation of BPD, which frequently occurs, results in individuals being perceived as worthless, and increased isolation from the mentally healthy population (Aviram, Brodsky, & Stanley, B., 2006). It has been suggested that clinicians may misattribute pathological behaviours to the individual’s personality, instead of the illness they are suffering from.
Thus, it is important for members of society to remember that BPD is, in fact, an illness like every other, and to adopt the view that these behaviours are not fully controllable by the patient. Even the most severe symptoms do not reflect an intention to undermine the therapist, or any other social contact, nor are they examples of moral failings or lack of willpower. Therefore, raising awareness for the illness and increasing understanding can aid BPD sufferers. If the public attempts to follow them down their rabbit hole and understands how things work in this parallel universe, the available social support may increase drastically. Social networks provide potentially positive, stabilizing, and supportive aspects (Beeney, Hallquist, Clifton, Lazarus, & Pilkonis, 2018), which could mitigate some of the struggles BPD sufferers face. Evidently, even though BPD can reduce the quality of life for many, a circle of social support – ideally combined with the right therapy (https://www.borderlinepersonalitydisorder.com/what-is-bpd/treating-bpd/) – empowers the hope of recovery from the bumps and bruises sustained from the trip to Wonderland.
Aviram, R., PhD, Brodsky, B., PhD, & Stanley, B., PhD. (2006). Borderline personality disorder, stigma, and treatment implications. Harvard Review of Psychiatry, 14(5), 249-256. doi:10.1080/10673220600975121
Beeney, J. E., Hallquist, M. N., Clifton, A. D., Lazarus, S. A., & Pilkonis, P. A. (2018). Social disadvantage and borderline personality disorder: A study of social networks. Personality Disorders: Theory, Research, And Treatment, 9(1), 62-72. doi:10.1037/per0000234
Kolla, N. J., Meyer, J., Sanches, M., & Charbonneau, J. (2017). Monoamine Oxidase-A Genetic Variants and Childhood Abuse Predict Impulsiveness in Borderline Personality Disorder. Clinical Psychopharmacology and Neuroscience, 15(4), 343–351. http://doi.org.proxy-ub.rug.nl/10.9758/cpn.2017.15.4.343
Scalabrini, A., Cavicchioli, M., Fossati, A. & Maffei, C. (2016) The extent of dissociation in borderline personality disorder: A meta-analytic review, Journal of Trauma & Dissociation, 18:4, 522-543, DOI: 10.1080/15299732.2016.1240738