Stabilising the vicissitudes

My partner has recently been diagnosed with borderline personality disorder. What are some of the things about BPD that I should know? What are the things I must try to do to understand her and help her?

Borderline personality disorder (BPD) is a mental health condition, characterised by emotionally unstable moods and difficulty in regulating emotions and relationships. It is a personality disorder that may begin in teens, and as the personality evolves, coupled with the experiences with the external environment, it can lead to repetitive patterns of symptoms. These usually range from:

* Fear of abandonment;

* Unstable relationships;

* Unclear or shifting self-image, body image and jobs;

* Impulsive, self-destructive behaviours;

* Self-harm or deliberate self-harm;

* Extreme emotional swings;

* Chronic feelings of emptiness;

* Explosive anger.

Causes

While active research is still being done to better understand BPD, it is learnt that the interplay of biological and psychological factors and stressors can lead to it. Those with a genetic history of parent/parents having BPD or other personality disorders have a higher chance of having BPD traits. Trauma history is often found in childhood, for example, abuse, abandonment, etc. Many folks have cPTSD (complex PTSD)-like history as well.

Is BPD different from BPD traits?

The “D” in BPD stands for a disorder, meaning symptoms that interfere with one’s various aspects of life, like day-to-day functioning, interactions with others, work, etc. A person diagnosed with only traits may not meet the full diagnostic criteria and hence, is said to have traits. The level of distress is lower in this case.

Treatment modalities: Each person is different and may need a different combination of treatments. The core principle is to combine medication (if needed for comorbid conditions), therapy and lifestyle changes.

* Therapy: Individual and group therapy;

* DBT: The gold standard therapy is called DBT or dialectical behavioural therapy. DBT helps individuals regulate their emotions, manage distress, and develop skills to improve relationships;

* Cognitive behavioural therapy (CBT): CBT can help individuals identify and change negative patterns of thinking and behaviour;

* Mentalisation-based therapy (MBT): MBT helps individuals develop the ability to understand their own and others’ mental states. It focuses on thinking about thinking and works on reducing impulsive behaviour;

* Schema therapy: Schema therapy focuses on identifying and changing negative patterns of thinking and behaviour that developed in childhood. It can be helpful for individuals with BPD to improve their self-esteem and form healthier relationships.

Medicines: To manage comorbid anxiety, depression, and mood swings, medications like antidepressants and mood stabilisers are commonly used.

Others: Mindfulness-based approach to eating, working out, and leading a balanced lifestyle helps treat mental health comorbidities.

Can BPD be cured?

Borderline personality disorder (BPD) cannot be cured. Most mental health conditions can be treated and managed but not cured. The idea of treatment should be to lead a balanced, happy, and healthy life and not look for quick easy fixes. With time and timely treatment, the BPD symptoms can be managed, monitored, and ultimately reduced in intensity.

Are BPD and bipolar disorder the same?

No. Bipolar disorder is a mood disorder characterised by manic and depressive phases, while BPD is a personality disorder. Mood swings can be seen in both but the intensity of a bipolar mood swing is typically more intense and well-defined than that of BPD mood changes. Furthermore, the insight is lost in psychotic episodes seen during bipolar phases while it is usually preserved in the latter.

What do you think are the main misconceptions surrounding BPD?

* One of the most common misconceptions is that BPD and bipolar are the same;

* Another common one is that those with BPD cannot lead a normal life or have steady relationships;

* A rather disturbing label is that people with BPD are just seeking attention.

Can someone with BPD lead a normal life?

Yes, they can. With the right treatment-management approach, folks can lead a normal, fulfilled, and healthy life.

Famous people diagnosed with BPD: Comedian and actor Pete Davidson, late singer-songwriter Amy Winehouse, and actress Angelina Jolie.

Movies on BPD: ‘Silver Linings Playbook’ (2012) had the lead actress Jennifer Lawrence portray BPD. Another movie that made BPD mainstream was ‘Girl, Interrupted’.

As a partner, you can:

Begin by using supportive jargon and not using the term “borderline” as a derogatory label. Remember that supporting a

partner with BPD can be challenging, but with patience, understanding, and effective communication, it is possible to maintain a healthy and fulfilling relationship.

* Information: Educate yourself about BPD from books, resources, and support groups. Try to speak to a mental health professional with your partner;

* Communication: Practice effective, healthy communication to help your partner develop a sense of security, and avoid blaming or criticising him/her. At the same time, assertively put across your needs and concerns;

* Boundary setting: Healthy boundaries need to be established to ensure that the relationship thrives. This also helps build trust and safety;

* Professional help: Encourage your partner to seek active help from mental health professionals in the form of therapy and/or medication;

* Be kind to yourself: know your limits and your needs, and ensure to make time for self-care activities, seek support from friends or family, and consider seeing a therapist yourself.

Send your questions to help@dreradutta.com