Behavioral Health Articles

Borderline Personality Disorder

by Jason Stepkovitch, MD

Many of the patients we see at our clinic have had difficult childhoods. Some have suffered from inconsistent or emotionally distant parenting. Others have been victims of severe physical abuse. Still others describe horrific accounts of having been raped, sometimes serially and repeatedly, throughout childhood.

How childhood trauma affects individuals is an area of intense debate and research in present day psychiatry. We know that some people who experience trauma will not develop psychiatric illness at all. We also know that an association between traumatic life experiences and psychiatric illness has been found for many psychiatric conditions, ranging from depression to post-traumatic stress disorder to personality disorders. There is a strong relationship between past trauma and an illness called borderline personality disorder, or BPD for short.

Some of the symptoms of BPD include chronic feelings of emptiness, and confusion about one’s identity, as well as questions about whether one has the right to one’s own feelings and opinions. In addition, there may be extreme changes in mood that tend to be affected by the person’s surroundings. Due to these extreme fluctuations in emotions, those with BPD will often have been told at some point that they have a form of bipolar disorder. They may have a history of trouble regulating their anger; they may even find themselves engaging in explosive flashes of anger and then later questioning or blaming themselves for being angry.

People with BPD may also have a pattern of intense interpersonal relationships and struggle between fears of abandonment versus fears of being too close. They have difficulty seeing the world in terms of shades of gray; instead they tend to see things as either all good or all bad. There may be a history of self-mutilation in the form of cutting or burning, as well as a history of poor impulse control, in the form of substance use, overdose attempts, or binging and purging behaviors.

Patients with BPD may provoke strong emotional responses from those around them, as well. Sometimes friends or family members feel sorry for them or feel that they need rescuing; at other times these same friends and family members feel strong negative reactions. This reflects the conflicted and confused sense of identity which people with BPD experience.

The incidence of BPD in the general population is approximately 2%, three-quarters of which are female. Figures vary, but some studies suggest that up to 75% of patients with BPD have a history of traumatic childhood experiences. Often, the sometimes recurrent suicidal actions by these patients are labeled by clinicians and others as “attention seeking.” Yet 3-10% of these patients actually do commit suicide.

BPD is a disorder of the formation of personality and not a pure mood disorder, such as major depression or bipolar disorder. Therefore, there is a tendency to view the illness with skepticism or even disdain. Many with this illness never seek treatment, while others enter the mental health system and are improperly diagnosed. Borderline Personality Disorder is treatable. Recently, a resolution to increase awareness about BPD and to observe a BPD month has been introduced in the House of Representatives by a bipartisan coalition led by Rep. Tom Davis (R-VA) and Chris Van Hollen (D-MD).

However, much work needs to be done, within both the medical and mental health systems, as well as in the general community, to de-stigmatize and educate people about this very legitimate, and often debilitating, mental illness.

Jason Stepkovitch, MD is a child psychiatrist with Cortland County Mental Health Services.