Amanda Lomanov, Psy.D.
Top 5 Myths about Borderline Personality Disorder
Updated: Sep 17, 2020
Borderline Personality Disorder is an archaic misnomer for a complex and chaotic internal experience that may look to others like oversensitivity and self-victimization.
The two main themes of the disorder are severe impulsivity and pervasive instability in interpersonal relationships, self-image, and emotional state. Many individuals with BPD can also exhibit self-harming behaviors and suffer from suicidal thoughts.
But apart from the overtly negative depiction of BPD in the media (e.g., shows like, Crazy Ex-Girlfriend, Insatiable, 13 Reasons Why, and movies like Single White Female), not much is known to the general public about BPD.
If you’ve seen my thoughts on diagnosis before, then you’ll know I am not usually a fan of labels. This is no different. But as a therapist who works with a lot of people who identify as having BPD symptoms, I feel inclined to dispel some of the misinformation going around.
1. BPD means there’s something wrong with you (and your personality)
I hate the term “personality disorder” because it suggests that the person is the problem. Western culture puts such a strong emphasis on individuality and independence that attacking someone’s personality seems like an attack on their fundamental identity, rather than a diagnosis describing a series of behaviors and reactions to the world.
But what really is a personality?
Psychologists have tried to distill it down to 5 basic spectrums of traits that can hardly capture the nuance of a living, breathing human. We call these Openness (to new experience), Conscientiousness, Extraversion, Agreeableness, and Neuroticism (tendency to experience negative emotions). Even among these, we can see that not one is determined purely by genetics or upbringing. You can be born with the most easy-going temperament in the world, but if you’re raised by someone who consistently tells you that the sky is falling, you’re going to develop neurotic tendencies.
So, the personality you develop isn’t a choice, so much as a reaction to a wide range of variables, from the temperament you were born with, to how much touch you experienced as an infant. Throw complex trauma like long-term patterns of abuse, neglect, or poverty into the mix and it’s a perfect storm for a “personality disorder.”
2. BPD is something you’re born with
As alluded to above, the personalities we develop into adulthood from childhood and adolescence are multi-determined and are therefore not fixed patterns of functioning that we are born with. BPD in particular is a reaction to past trauma that results in extreme reactions to present-day trauma triggers, which can look a lot like our instinctual fight, flight, or freeze responses to threat. For example, fight might look like extreme rage that doesn’t seem to make sense to others given the situation. Flight might look like social isolation, and freeze might look like someone who is physically present, but socially withdrawn, maybe even losing the ability to speak or interact with others momentarily when under extreme stress.
BPD symptoms usually follow when a person who is born with a naturally sensitive temperament experiences consistent invalidation and/or early neglect, which might look like a highly self-focused or overstressed, unavailable parent, or trauma, in the form of domestic violence, or physical, sexual, and/or emotional abuse. These experiences of trauma from an early age result in the development of what might feel like different personalities (and that unstable sense of self) for a person with BPD.
3. BPD is incurable and no one ever gets better
There are actually a lot of ways to help someone with BPD symptoms, but that person must be ready and willing to make changes in their lives. (So does anyone else who wants to go to therapy, by the way.)
People with BPD might get a bad rap because sometimes it can be harder for them to see that they play a role in the conflicts and circumstances that bring them into therapy. (That is also true of many other people, but for those with BPD, the role they play in their interpersonal conflicts is usually apparent to almost everyone around them.)
The most common and well-researched treatment for BPD is DBT, or Dialectical Behavior Therapy, which was developed by Marsha Linehan, whom herself identifies with the diagnosis of BPD. This treatment is a great choice for someone whom is aware of how the intensity of their emotions affects their life and is looking for skills to help manage them. Other researched approaches include Schema Therapy, which mixes CBT with more experiential techniques.
In my practice, I draw from relational psychodynamic therapy (which focuses on the therapeutic relationship) and somatic (or body-focused) approaches. This combination helps individuals reprocess stuck emotions and integrate new insights gained through the psychodynamic work into the body for long-term change. I also incorporate DBT, either through active skills coaching or hands-off psychoeducation, depending on the needs of my clients.
So even though there are ways to treat BPD, like with any mental health disorder, the treatment is only as effective as the readiness of the person who is receiving it -- not to mention the expertise of the clinician.
4. Medication can’t help with BPD
A large part of BPD as mentioned is an extreme emotional reactivity that is not experienced and cannot be understood by most others who do not struggle with BPD symptoms. Although there is no medication to “cure” BPD, I have seen mood stabilizers help to reduce the tormenting anxiety that drives paranoia in social situations, increases irritability and edginess, and fans anger into full-blown rage. They can also help to stabilize the levels of depression that dip into suicidal thoughts and feelings.
There are a number of options to discuss with your psychiatrist or psychiatric nurse, and many of the side effects are less encumbering than those of typically prescribed antidepressants and anxiolytics.
Of course, while medication can help with some aspects of BPD, traditional therapy is recommended for working through a history of trauma, abandonment triggers, feelings of emptiness, stability of self, and healthy boundary-setting.
5. No clinician wants to work with BPD
Although a google search may not yield the best results, many therapists know other therapists who have experience treating individuals with BPD symptoms. Consider calling around to local therapists you might find through google or Psychology Today and asking for recommendations.
Some therapists in private practice may not work with clients who are actively or even passively suicidal, but often can refer you to someone who might, or can help you think about whether hospitalization may be right for you. If you think you may be a harm to yourself or somebody else, consider checking into your local ER, or calling 911.
You can also call the National Suicide Prevention Lifeline 1-800-273-8255 for free and confidential support, prevention and crisis resources. This line is also available to help family members of those who might be in need find key resources.
If you’re not sure you need hospitalization right now, but you are in need of extra help beyond one or two hours of therapy a week, consider looking for an Intensive Outpatient (IOP) Treatment center, which often offer DBT and other group therapies for multiple hours per day at least 3-4 days per week.
If you are having a hard time finding a good therapeutic fit, keep looking. Try at least three or four sessions with the same person. Sometimes it takes time to see if we might be a good match with someone. Remember, there is no “right” therapist for any one person, but they should help you feel comfortable and safe.
about the author
My passion is helping people connect with their most authentic selves. Through this blog, I hope to offer resources to demystify psychotherapy and encourage you to think about your mental wellness.
In my integrative psychotherapy practice in Echo Park, my mission is to support you in finding your best self and living an examined life.