The term Borderline Personality Disorder or BPD isn't the most well-known mental illness, compared to Depression, Bipolar Disorder, and Anxiety but it affects 1.6 percent of people in the United States and 2 percent of people in Canada. BPD is a Personality Disorder which, by definition, means: A deeply ingrained and maladaptive pattern of behaviour of a specified kind, typically manifested by the time one reaches adolescence and causing long-term difficulties in personal relationships or in functioning in society. Personality Disorders have three Clusters; Cluster A (Odd, Eccentric, Bizarre), Cluster B (Dramatic, Erratic), and Cluster C (Anxious, Fearful). Our friend BPD falls under Cluster B and can not only be debilitating, frustrating, and tiring for us, but it can also affect the lives of those around us.

Finding Our Way: A Not-So-Fun Adventure

In order to be diagnosed with BPD according to the DSM-IV (which stands for Diagnostic and Statistical Manual for Mental Disorders), a patient has to experience five out of the nine following symptoms.

The first symptom is frantic efforts to avoid real or imagined abandonment. We scramble to avoid rejection or abandonment from those who are close to us, whether it is actually a threat or not. These fears of abandonment are caused by cognitive distortions and paranoia and often leads to us isolating ourselves and forcing the abandonment to happen either way but on OUR terms.

The second symptom is a pattern of unstable and intense interpersonal relationships characterized by alternating between extremes of idealization and devaluation. We jump erratically between completely loving someone to completely hating someone within a couple of seconds and over the smallest of things. These shifts cause extreme problems with our interpersonal relationships, often causing us to not see the positive features in someone when we "hate" them, or not being able to see the flaws in someone when we "love" them.

The third symptom is identity disturbance, which is a markedly and persistently unstable self-image or sense of self. This essentially means that, just like in most borderline symptoms, we are either on one side of the scale or the other; we either think we are smoking hot or vile, ugly creatures. There is no gray scale. As for the unstable sense of self, we often feel like chameleons, blending in to our environment. We often don't have a sense of who we really are due to the fact that we are constantly changing our "personality" to suit the needs of others, making it hard for us to identify our true selves.

The fourth symptom is impulsivity in at least two areas that are potentially self-damaging, for example: spending, sex, substance abuse, reckless driving, binge eating, etc... When emotions are running high, we often end up being reckless and impulsive. Our emotions fuel our impulsivity and since our emotions our subjected to change at any moment, our choice of impulsive activity will likely change as well.

The fifth symptom is recurrent suicidal behaviour, gestures, or threats, or self-mutilating behaviour. BPD patients, just like Bipolar patients experience bouts of depression, frequently. This means that they will experience many of those symptoms, such as self-mutilation, suicidal threats, gestures, and even attempts.

The sixth symptom is affective instability due to a marked reactivity of mood, for example: intense episodic dysphoria, irritability, or anxiety, which usually lasts a few hours and only rarely lasts more than a few days. These mood swings can also touch on other emotions such as happiness, depression, and even mania.

The seventh symptom is chronic feelings of emptiness. For those who don't experience this symptom, it makes absolutely no sense, but for those who do, it makes perfect sense. The best way to describe it is it's like having this void in your chest that, no matter what you try to fill it with (money, friends, relationships, sex, fancy new toys, anything), it never seems to get fuller, if anything, it seems emptier the more you throw at it.

The eighth symptom is inappropriate, intense anger or difficulty controlling anger. This symptom is quite straight forward; we have short fuses.

The ninth symptom is transient, stress-related paranoid ideation or severe dissociative symptoms. This means that during times of great stress, on odd occasions, patients can experience paranoid ideas. They can also feel out of touch with reality, which is a coping mechanism during periods of trauma or if they are extremely stressed.

There is a tenth symptom, which is rare, but was mentioned by a couple of psychiatrists I saw, in which they told me that it is possible for patients to have hallucinations as a part of their BPD. These hallucinations can be auditory or visual.

The Four Types

With BPD, there are four subtypes or Classes of BPD, the Discouraged Borderline, the Impulsive Borderline, the Petulant Borderline, and the Self-Destructive Borderline.

The DiscouragedBorderline is known for their clingy and codependent behaviour, tending to follow along in a group setting although seeming dejected. They are usually brimming with disappointment and anger under the surface directed at those around them. They are more likely to engage in self-mutilation and even suicide. They seek approval but also tend to avoid people, feel unworthy, and can trend toward depression.

The Impulsive Borderline is known to be highly charismatic, energetic, and engaging. They can be superficial, flirtatious and elusive, seeking thrills and becoming quickly bored. They thrive on attention and excitement and often get themselves into trouble after acting first and thinking later. This can lead to substance abuse and self-injurious behaviour as they seek approval from those around them and seek to avoid disappointment and abandonment

The PetulantBorderline is known for its u npredictability, irritability, defiance, and impatience. They tend to be stubborn, pessimistic, and resentful as well. They teeter between extreme feelings of being unworthy and anger. They can explode with these episodes of anger. Petulant borderlines fear being disappointed by others but also can’t seem to help wanting to rely on them. They tend to be passive-aggressive and can display self-harming behaviour to get attention.

TheSelf-Destructive Borderline engages in self-destructive behaviour. At times they may or may not even be aware of their destructive nature. They are bitter and self-loathing. They have no sense of self and are terrified of being abandoned. They may hurt themselves in an effort to feel something. They are most likely to engage in risky behaviour like reckless driving and degrading sexual acts.

But... How? Why Me?

We always ask ourselves, How did this happen? Why me? We are constantly looking back at our lives, frantically turning the pages and wondering where we went wrong and what we did to end up the way we did, not knowing that there are certain factors that predispose us to BPD. Those factors are our Environment, our Genetics, our Basal Personality, and our Brain Structure.

Starting with our environment, there are multiple situations that can happen in your childhood and adolescence that can cause you to develop BPD. For example, if there was family instability, neglect, losing a parent, or abuse while you were growing up, you are more likely to develop a personality disorder as a coping mechanism.

Next, our genetics also play a role in BPD. BPD is about five times more likely to occur if a person has a close family member (first-degree biological relatives) with the disorder.

Not only that, your personality can predispose you to BPD as well. Studies suggest that people predisposed to impulsive aggression have impaired regulation of the neural circuits that modulate emotion.

Finally, the very structure of our brain can affect your development of BPD. Studies show that people with BPD have structural and functional changes in the brain, especially in the areas that control impulses and emotional regulation.

Is There Hope?

In a world where everything seems dark and hopeless, there is one bright side to BPD, with the right therapy and the right combination of medication (which is unique to every individual), the symptoms become manageable and the "flare ups" become less frequent as you follow your individualized treatment plan.

One of the best types of psychotherapy's for BPD is known as Dialectic Behaviour Therapy or DBT. The goal of DBT is to transform negative thinking patterns and destructive behaviors into positive outcomes. This therapy, combined with other therapies can help in changing self inflicted symptoms of a patients BPD while medications such as anti-depressants, anti-psychotics and mood stabilizers can help and prevent emotional symptoms.

Being diagnosed as a Borderline is not an "End of the World" diagnosis. It is possible to live a fulfilling life with BPD, it just takes a bit of time to get there, but the journey there isn't without its heartache and its adventures. While some parts may be painful, others can be an enjoyable experience as we heal and move on with our lives. There is always hope.